This case concerns a 60-year-old woman who was seen in the emergency room for flu-like symptoms, dizziness, weakness, and cough. She reported dark stools and several days of dark colored urine. Previous history revealed suspected hemolytic anemia and mild thrombocytopenia. At admission, her hemoglobin was 5.9 g/dL and platelet count was 100 x 10^sup 9^/L. Evidence of hemolysis included: total bilirubin 1.6 mg/ dL, lactate dehydrogenase 850 U/L, and a positive DAT with IgG and C3. She received four units of packed red blood cells and her hemoglobin stabilized at about 10 g/dL. Upon outpatient follow-up, the complete blood count showed a worsening of the cytopenias with a hemoglobin of 7.7 g/dL and platelet count of 60 x 10^sup 9^/L. The differential showed many abnormalities including marked polychromasia, nucleated red blood cells, basophilic stippling, schistocytes, Pappenheimer bodies, and Howell-Jolly bodies. Of particular interest was phagocytosis of platelets by neutrophils. The reticulocyte count was 37%. The diagnosis of Evan's syndrome, a severe thrombocytopenia with warm autoimmune hemolytic anemia was made. This syndrome is diagnosed after other causes of progressive cytopenias have been ruled out including myelodysplasia, malignancy, and liver and kidney dysfunction. There is no definitive treatment.
Shirlyn B McKenzie PhD CLS(NCA), Brandon Hiller, University of Texas Health Science Center at San Antonio, Department of Clinical Laboratory Sciences, San Antonio TX.
Copyright American Society for Clinical Laboratory Science Summer 2004
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