A 23-year-old man of nohern European lineage presents with anemia. His father and paternal aunt had a similar illness that was treated successfully by splenectomy. His peripheral blood smear is similar to that shown in the illustration. Which of the following additional abnormalities is expected?
Bilirubinuria
high mean corpuscular volume
Increased direct (conjugated) serum bilirubin
Polychromatophilic erythrocytes on peripheral blood smear
- Spherocytes are present in given peripheral smear; along with the history, strongly suggests diagnosis of hereditary spherocytosis. - Similar cells are also observed in warm antibody autoimmune hemolytic anemia. - These two conditions can be distinguished by direct Coombs test, which is negative in hereditary spherocytosis & positive in warm antibody autoimmune hemolytic anemia. - An expected finding in HS is increase in indirect (unconjugated) serum bilirubin, not direct (conjugated). - Polychromatophilic erythrocytes are an expected finding, as in any hemolytic anemia.
Hemolytic Anemias: Basic concepts and classification