Case 8 – update 1

So, your plan so far includes haematinics, haemolysis screen, HIV, autoimmune screen and a blood film.  Some of these have been added onto samples taken by the GP.  You speak to the GP further and he reports no new medication.  No glossitis.

The investigations show:

Bilirubin 70 (3-17umol/L)

N- LFTS

Reticulocytes 320 (26-130 X109/L)

LDH – 470 (70-250 iu/L)

Haptoglobin – 20 (36-195mg/dl

Coombs – negative

B12 and folate – Normal

Ferritin – 7   (12-300ng/mL)

Blood film has been requested but awaiting review.

Oh and Proctors sign is negative!!

What can you conclude from the investigations so far?

What would you do next?  The GP wants to know whether he should be admitted? Or referred to haematology?  Any further questions to ask the GP before you make your decision?

What would you be looking for on the blood film?

Any thoughts on diagnosis/treatment?

About TeamHaem

Online education and discussion about all things haematological
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