hemolytic anemia/autoimmune hemolytic anemia

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Hematology

hemolytic anemia

autoimmune hemolytic anemia

Case History

A 30-year-old woman presents to the emergency department with an acute onset of severe fatigue, dizziness, and dark urine following a recent viral illness. Her vital signs are blood pressure 100/60 mm Hg, pulse 110/min, and respirations 18/min. Physical examination reveals marked pallor, prominent scleral icterus, and moderate splenomegaly. There is no evidence of lymphadenopathy or rash. Peripheral blood smear analysis shows numerous spherocytes without central pallor. Direct Coombs' test is positive for IgG. Considering these findings, what is the most likely diagnosis and the appropriate initial therapeutic intervention?

Lab Parameter	Value	Reference Range
Hemoglobin	70 g/L	125–170 g/L
Leukocyte count	10 x 10^9/L	3.5–10.5 x 10^9/L
Platelet count	180 x 10^9/L	130–380 x 10^9/L
Total Bilirubin	119 µmol/L	<22 µmol/L
Conjugated bilirubin	3 µmol/L	<5 µmol/L
Alanine aminotransferase	34 U/L	3-36 U/L
Gamma-glutamyl transferase	15 U/L	10-30 U/L
Urea nitrogen (BUN)	3 mmol/L	2.5-8.0 mmol/L
Serum creatinine	61 µmol/L	70-120 µmol/L
Serum LDH	400 U/L	80-280 U/L
Haptoglobin	0.1 g/L	0.5-2.2 g/L
Reticulocyte count	9 %	0.5%–1.5%
Urinalysis	Dark, positive for blood, no red blood cells on microscopy	Normal

A ) Warm autoimmune hemolytic anemia (AIHA) and immediate initiation of high-dose corticosteroids.

B ) Hereditary spherocytosis and genetic testing for ankyrin gene mutations.

C ) G6PD deficiency and urgent transfusion with packed red blood cells.

D ) Paroxysmal nocturnal hemoglobinuria (PNH) and flow cytometry for CD55/CD59 deficiency.

E ) Cold agglutinin disease and rituximab with avoidance of cold exposure.

Edit question

Lab Parameter	Value	Reference Range
Hemoglobin	65 g/L	120-150 g/L
Leukocyte count	4.0 x 10^9/L	3.5-10.5 x 10^9/L
Platelet count	115 x 10^9/L	130-380 x 10^9/L
Reticulocyte count	18%	0.5%-1.5%
Lactate dehydrogenase	550 IU/L	100-205 IU/L
Haptoglobin	Undetectable	0.3-2.0 g/L
Total Bilirubin	48 micromol/L	<21 micromol/L
Indirect Bilirubin	41 micromol/L	<17 micromol/L
Creatinine	72 micromol/L	45-90 micromol/L
Peripheral blood smear	Numerous spherocytes, polychromasia	Normal morphology

Lab Parameter

Value

Reference Range

Hemoglobin

65 g/L

120-150 g/L

Leukocyte count

4.0 x 10^9/L

3.5-10.5 x 10^9/L

Platelet count

115 x 10^9/L

130-380 x 10^9/L

Reticulocyte count

18%

0.5%-1.5%

Lactate dehydrogenase

550 IU/L

100-205 IU/L

Haptoglobin

Undetectable

0.3-2.0 g/L

Total Bilirubin

48 micromol/L

<21 micromol/L

Indirect Bilirubin

41 micromol/L

<17 micromol/L

Creatinine

72 micromol/L

45-90 micromol/L

Peripheral blood smear

Numerous spherocytes, polychromasia

Normal morphology