Q:

What is the most likely diagnosis?

waelhammad
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2022-11-15
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A 3 1 -year-old graduate studen t From Africa who immigrated to the Unites States 6 mon ths previously presen ts to the emergency departmen t complaining of general-ized fatigue and dark urine For 1 -week duration . Patien t denies Fever or recent infec-tions. Physical exami nation reveals an alert and Ful ly orien ted Female with pal lor.

Laboratory workup shows hemoglobin of LJ.1 g/dL, mean corpuscular volume (MCV) of 1 06 FL. leukocyte count of 7,500/,LLL. platelet count of 3LJ,OOO/,LLL. and LDH of 3,700 U/L. Urine is grossly dark, and analysis reveals 1 -2 RBC/HPF Direct an tiglobin test is negative. Peripheral blood smear is shown below.

What is the most likely diagnosis?

  1. Hemoglobin H disease
  2. Beta thalassemia major
  3. Aplastic anemia (AA)
  4. Thrombotic thrombocytopenic purpura (TTP)
  5. Autoimmune hemolytic anemia (AIHA)
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waelhammad
2022-11-15
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D. Peripheral slide reveals increased number of fragmented red blood cells (RBC)­ schistocytes. This is characteristic of microangiopathic hemolytic anemia (MAHA). The clinical picture ofMAHA, thrombocytopenia, negative direct antiglobin test, and hemoglobinuria (1-2 RBC/ HPF in urine) supports the diagnosis ofTTP.

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