Case 19 – update 5

For the start of the case scroll below… or click

So far our patient with chronic neutropenia due to myelodysplasia has been admitted with fevers and anaemia.  She only had a transfusion a matter of days ago, so her anaemia is unusual as she only normally requires transfusions every two months.  She has hyperbilirubinaemia and a raised LDH, in keeping with haemolysis.  She hasn’t mounted an adequate bone marrow/reticulocyte response due to reduced marrow function secondary to myelodysplasia.   On seeing spherocytes on the film, the transfusion laboratory have performed a direct antiglobulin test (direct Coombs’ test) which has been positive, indicating that the red cells have been coated in an antibody (either auto- or allo-immune).

The report from the laboratory indirect antiglobulin test has found that anti-E his present in the patient’s plasma, which was previously not there.  Fortunately the laboratory has red cells that are E antigen negative to hand and therefore the patient can be transfused.


  • What is the most likely reason for the patients presentation? How is this managed?
  • What implications does this have in the future for the patient?

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