A 30 year old presented with a skin lesion in his right axilla. A presumptive diagnosis of staphylococcal skin carbuncle is made & patient is treated with empiric trimethoprim/ sulfamethoxazole. After 2 days, the patient came to emergency with excessive weakness, abdominal pain & dark coloured urine. O/E- vitals are normal & jaundice is present. Lab studies show a drop in Hb from 14 g/dl to 8 g/dl & rise in bilirubin levels. Urine dipstick is positive for bilirubin. Peripheral blood smear is shown below. What could be the possible diagnosis of the patient?
Glucose 6-phosphate dehydrogenase (G6PD) deficiency
Hemolytic-uremic syndrome
Hereditary spherocytosis
Iron deficiency anaemia
PBF shows bite cells, anisocytosis, and spherocytes with jaundice after receiving sulfamethoxazole which makes the diagnosis of glucose 6-phosphate dehydrogenase (G6PD) deficiency. Triggers for acute haemolytic anemia in G6PD deficiency: Fava beans Infections Drugs- primaquine, dapsone, sulfamethoxazole, and nitrofurantoin Hemolytic attack stas with malaise, weakness, and abdominal or lumbar pain. After an interval of several hours to 2-3 days, the patient develops jaundice and often dark urine. Lab studies- hemoglobinemia, hemoglobinuria, high LDH, and low/absent plasma haptoglobin Diagnosed by semiquantitative or quantitative RBC tests or by DNA testing Hemolytic-uremic syndrome - cause microangiopathic hemolytic anemia with prominent schistocytes Iron deficiency- causes a microcytic and hypochromic anemia
Sickle Cell Disease, G6PD deficiency and other Hemolytic Anemia