A 57-year-old woman presents with severe anemia, shortness of breath, and dizziness. Explore the diagnostic journey of this complex Hemolytic Anemia case.
A 57-year-old woman presented to the emergency department with a 3-day history of shortness of breath and dizziness. The physical examination was notable for pallor. Laboratory studies showed a hemoglobin of 4.4 g per deciliter (reference range, 11.6 to 15.5), an elevated reticulocyte count, an elevated lactate dehydrogenase level, and a low haptoglobin level. The results of hemoglobin electrophoresis and glucose-6-phosphate dehydrogenase testing were normal, and methemoglobin and direct antiglobulin tests were negative. A peripheral blood smear (left, Giemsa staining) showed poikilocytosis, nucleated red cells (black arrows), and polychromatic cells (white arrows). The peripheral blood smear also showed bite cells (left, red arrows), blister cells (left, asterisks), and erythrocyte inclusions (middle, Giemsa staining). The erythrocyte inclusions were identified as Heinz bodies on the basis of positive staining with methyl violet (right). Which of the following is the most likely etiology of this patient’s hemolytic anemia?
