Hemolysis Case 3

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Describe the CBC trend

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Progressive leukocytosis and anemia

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What could cause such a rapid drop in Hb?

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Hemorrhage with crystalloid resuscitation
Hemolysis

The patient was not bleeding. He was febrile and hypotensive. His plasma was noted to be dark brown. What is the most likely diagnosis?

a

Thrombotic thrombocytopenia purpura

b

Sickle cell disease

c

Clostridial sepsis

d

Autoimmune hemolytic anemia

The patient’s smear showed similar findings to the following, namely the presence of many microspherocytes (red arrows):

Source

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Why is his haptoglobin (Hp) normal

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VERY COOL: patients with fulminant hemolysis may have blockade of CD163, the macrophage receptor that takes up the Hp-Hb complex; the Hp assay measures both free Hp and the complex!

Unfortunately, the patient passed away within hours of presentation. His blood cultures showed the following:

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