Case 63 – update 3

Our four year old has spherocytes on the blood film. These are seen in various types of haemolytic anaemias – mainly autoimmune haemolysis and hereditary spherocytosis. There is a lack of polychromasia reflecting the lack of marrow turnover and linking into the low reticulocyte count. The direct antiglobulin test is negative pointing away from an autoimmune haemolytic anaemia, which would be rare (but not impossible) at this age.

 

With haemolysis the reticulocyte count should be elevated but in this case it is not. Viral infections can temporarily interfere with erythropoiesis, especially parvovirus B19. In patients who rely on increased red cell production due to haemolysis this temporary reduction in erythropoiesis can be enough to result in anaemia. In patients with normal red cell survival this should not be a problem (unless the virus persists due to immunosupression).

 

Results show:

  • Parvovirus IgM detected in keeping with recent/ongoing infection

 

Here is a blood film from the baby’s father:

Leica Picture

Questions:

  • What does the father’s blood film show?
  • Other than a blood transfusion, is there anything else you would consider giving to the four year old?
  • What is the final diagnosis and how would you confirm this?

 

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