A 32 -year-old female is found on routine physical examination to have splenomegaly. She reports no acu te change in her energy levels. However. she does note bei ng more easily fatigued duri ng heavy physical activity as long as she can remember. Patien t re-ports a h istory of cholelithiasis diagnosed 1 0 years previously; however. she elected not to undergo cholecystectomy. Mild splenomegaly is noted on physical examination . Laboratory workup reveals hemoglobin 11 .2 g/dl. mean corpuscular volume (MCV) 85 fl. leu kocyte count 6.500/,LLL. and platelet count of 361 . 000/,LLL. I ndirect bil irubin level ismini mall el vated and tneoireccanriglooin--resns negative. -reriph-eraJ-blood· smear is shown below.
What is the most likely diagnosis?
- Iron-deficiency anemia
- Beta thalassemia intermedia
- Hereditary spherocytosis (HS)
- Autoimmune hemolytic anemia (AIHA)
- Anemia of chronic disease
Medicine
C. Peripheral blood smear reveals a single population of red blood cells (RBC) with no central pallor zone consistent with spherocytes. Patient's prior history ocholelithiasis at a young age and normal mean corpuscular volume (MCV) and normal other blood lineages, in addition to spleno-megaly, is consistent with a diagnosis of hereditary spherocytosis with chronic mild hemolytic anemia.
Negative direct antiglobin test makes the diagnosis of AIHA unlikely. Normal MCV argues strongly against beta thalassemia intermedia.
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