TRANSFUSION MEDICINE - the UCLA Department of Pathology ...

HISTORYA 73-year-old woman underwent surgical repair of a ventral hernia. After anuneventful postoperative course, she was discharged on postoperative day 4. Aroundday 9, she developed progressive weakness, lightheadedness, and dark urine, and had1 episode of emesis of clear fluid. She presented to the authors’ institution on day 14.Review of all other systems was unremarkable. Her medical history was significantfor colon cancer 7 years earlier treated with surgical resection and chemotherapy,hypertension, hyperlipidemia, hypothyroidism, and gastroesophageal reflux disease.Her outpatient medications included carvedilol, nifedipine, captopril, losartanhydrochlorothiazide,ezetimibe-simvastatin, thyroxine, esomeprezole, ranitidine,aspirin, and tramadol.transfusion medicineTM 11-4© ASCP 2011Her vital signs were: blood pressure, 128/93 mmHg; pulse rate, 81/min; respirations,18/min; and temperature, 98.4°F (36.9°C). Oxygen saturation on room air was100%. Her abdominal wound was healing with no evidence of bleeding or infection.No skin rashes, petechiae, ecchymoses, or mucosal hemorrhages were present. Thefecal occult blood test result was negative. The rest of her physical examination resultswere unremarkable.Relevant admission laboratory results are shown in Laboratory Data. Thepatient had severe anemia with evidence of hemolysis, including reticulocytosis,unconjugated hyperbilirubinemia, a low haptoglobin level, an elevated level of lactatedehydrogenase, and hemoglobinemia. The peripheral smear showed abundantmicrospherocytes and no schistocytes. Her blood type was group A Rh+. Theantibody screen result was negative. The direct antiglobulin test (DAT) result waspositive for IgG and negative for C3. An acid elution was performed, and the eluatewas nonreactive with reagent red blood cells (RBCs). She was admitted for RBCtransfusions and evaluation of her hemolytic anemia.LABORATORY DATA.Test Patient Result Reference RangeWhite blood cell count, ×10 3 /µL (×10 9 /L) 5.50 (5.50) 3.28-9.29 (3.28-9.29)Red blood cell count, ×10 6 /µL (×10 12 /L) 1.96 (1.96) 3.76-4.93 (3.76-4.93)Hemoglobin, g/dL (g/L) 6.2 (62) 11.5-14.6 (115-146)Hematocrit, % 18.7 34.0-42.1Platelet count, ×10 3 /µL (×10 9 /L) 207 (207) 143-398 (143-398)Mean corpuscular volume, fL 95.4 79.0-95Absolute reticulocyte count, ×10 6 /µL (×10 9 /L) 0.1942 (194.2) 0.0273-0.1072 (27.3-107.2)Haptoglobin, mg/dL (µmol/L)