Case 50 part 1 – update

We were reviewing the marrow smear from an elderly gentleman with weight loss and macrocytic anaemia. Further results include:

  • Reticulocyte count 276×10*9/L
  • Bilirubin 54ug/L
  • LDH 1056U/L
  • DAT IgG 4+

 

The above is consistent with warm autoimmune haemolytic anemia. The bone marrow showed these features:

 

This is consistent with erythrophagocytosis, which can be seen in haemolytic anaemia.

 

Questions:

  • What are the causes of warm haemolytic anaemia?
  • Any further investigations on the patient’s bone marrow?
  • Any further investigations in the peripheral blood?
  • What would be first line treatment for warm AIHA?

 

Please reply to us (@TeamHaem) 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 days so keep checking #TeamHaem on Twitter for more information.

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