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A 22-year-o\d female graduate student from Africa presents with complaints of chills and fever for the past 2 days_ Physical examination reveals fever of 1 OLJ oF and spleno megaly. Laboratory workup shows leukocyte count of 7.800/ ,LLL. hemoglobin 8. 7 g/dl. and platelet count 11 0.000/JLL. Direct antiglobin test is negative. Peripheral blood smear is shown below.
What is the most likely diagnosis?
- G6PD deficiency induced anemia
- Hemoglobin C disease (homozygous, HbCC)
- Hemoglobin H disease (HbH disease)
- Malarial anemia
- Hereditary spherocytosis (HS)
Medicine
D. Peripheral smear reveals schizonts and gametocytes, which occupy almost the entire erythrocyte. This picture is most likely consistent with Plasmodium vivax infection. The presence of parasite-filled RBCs argues strongly against other diagnoses. There is no evidence of spherocytes to support the diagnosis of HS. Cases with HbH disease would reveal severe microcytosis and the pres ence of target RBCs. Patients with HbC disease would also be expected to exhibit target RBCs and the characteristic RBC crystals. The clinical presentation, especially with high fever, is not consistent with the diagnosis of G6PD deficiency.
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