Hemolysis Case 2

Describe the CBC

Click for Answer

Macrocytic anemia with anisocytosis and thrombocytopenia.

After ruling out spurious causes, what is the first branchpoint in the differential diagnosis of macrocytic anemia?

Click for Answer

Is the reticulocyte count appropriate (high) or inappropriate (low)?

The reticulocyte count is appropriate (absolute count > 120 x 10⁹/L). When considering the rest of the labs, which is most likely diagnosis (the patient was NOT on an anticoagulant):

Thrombotic thrombocytopenia purpura

Valve hemolysis

Sickle cell disease

Wilson’s disease

The elevated DIRECT bilirubin and INR point to liver disease.

Babesiosis

If this were Wilson’s disease what serum lab value(s) would you expect to be low?

Haptoglobin

Ceruloplasmin

Copper

Ferritin

The following were the patient’s serum ceruloplasmin and liver copper levels at time of presentation:

1 / 0