Hemolysis Case 2
After ruling out spurious causes, what is the first branchpoint in the differential diagnosis of macrocytic anemia?Click for Answer
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
Sickle cell disease
The elevated DIRECT bilirubin and INR point to liver disease.
If this were Wilson’s disease what serum lab value(s) would you expect to be low?
The following were the patient’s serum ceruloplasmin and liver copper levels at time of presentation:
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