Case 19 – update 5

For the start of the case scroll below… or click https://teamhaem.wordpress.com/2014/01/26/case-19-the-beginning/

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.

Questions:

  • 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?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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This entry was posted in Anaemia, Bone marrow failure, Transfusion and tagged , , . Bookmark the permalink.

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