#MorphologyMonday A patient presents to their GP looking and feeling a little yellow. The blood film showed the following. What's going on? After discussing with the Haem Reg, you decide to do a coombs test. Can you predict the result of that? #OnlyCells #RedCells
@BloodScientist Filled with spherocytes ! What's the age and PMH of this patient?
@BloodScientist This is a classical spherocytosis in an Auto immune hemolytic anemia pt
@BloodScientist Spherocytes galore... Suspect DAT will be negative Suspect hereditiary spherocytosis but if DAT +ve than could also be AIHA Pts age would be important to know as well as LDH/Retic /H/o gallstones ?
@BloodScientist Spherocytes ++ DAT if positive, will indicate AIHA
@BloodScientist Spherocytosis Polychromasia (predict high retic count) No abundance of cell fragments. Extravascular hemolytic, probably autoimmune in nature. Lack of agglutination on film suggests warm AIHA over cold aggs. If DAT neg, hereditary spherocytosis should be excluded
@BloodScientist If this is let’s say AIHA then with these many spherocytes I would expect reasonable RE stress like perhaps a HJ body or two / can’t see none So could be HS with decompensation DAT will tell 😁
@BloodScientist Hereditary spherocytosis (check for medical patient or family medical story) or Autoimmune Hemolytic anemia (TCD is supposed to be positive). Mean Reticulocytes volume has been reported to discriminate between the 2 conditions (<100 fL in HS adult pats). pubmed.ncbi.nlm.nih.gov/11698268/
@BloodScientist Spherocytes, ?Touch of polychromasia and rouleaux - indicating haemolytic process. Possible cold AIHA. DAT Pos (C3d) would confirm.
@BloodScientist Polychromatophilic erythrocites (reflects an increase in the erythrocyte response, so it's a regenerative anemia) this added to the presence spherocytes ++ makes me think of AIHA. The DAT positive will confirm my diagnosis.