This week’s unusual case was sent to us by John Peters, Charge Scientist, Hematology Laboratory Middlemore Hospital Auckland New Zeeland.
The details are: Blood from a 10 day old, Chinese twin with prolonged jaundice.
A FBC was performed and the results are as follows:
Hb = 71 g/L
Hct = 0.22
MCV = 109 fL
Plt = 511 xE9/L
WBC = 34.1 x E9/L
NRBC = 7.03 x E9/L
Normal WBC differential
A smear was prepared on a Sysmex SP1000 slide maker stainer and MGG-stained.
Differential count was performed using the CellaVision DM96.
The cells looked like this:
Click on the cells to enlarge them.
What do you think?
The jaundice is possibly obstructive. The target cells are generally macrocytic, however, in cases of intrahepatic and extrahepatic obstructive jaundice, the target cells present can be normocytic or macrocytic. N’RBCS and Schistocytes confirms the hemolytic process.
maternal/fetal transplacental bleed. Mother is different blood type THAN baby.
maternal/fetal transplacental bleed. Mother is different blood type that baby.
Haemolytic disease of the newborn example anti-K
nrbc, spherocytes , polychromasia, red cell fragments, contracted cells target cells and platelet clumps.
Blister cells, bite cells, spherocytes, polychromasia and NRBCs. Probable oxidative haemolysis. ?G6PD deficiency. ?Exposure to oxidative chemicals – possibly infant clothing stored in mothballs.
Hemolytic anemia; increased polychromatophilia, helmet cells, spherocytic RBC, target cells. This could possibly be a G6PD deficiency (enzyme defect).
The presence of schistocytes, NRBC’s, spherocytes and polychromasia were proven hemolysis. The observation of bite cells was suggested possibility G6PD deficiency.
There are obvious schistocytes with spherocytes.
Would be curious about the direct Coombs test (some type of antibody coating the red cells).
Hemolytic anemia; increased polychromatophilia, helmet cells, spherocytic RBC, hydrocytes (swollen RBC), target cells. This could either be a spherocytosis (membrane defect); hydrocytosis or permeability (osmotic hemolysis defect); or G6PD deficiency (enzyme defect).
NRBC, reticulocytes, spherocytes and bite cells:
Some kind of hemolytic anemia, possibly G6PD deficiency.
The presence of spherocytes, schistocytes, and NRBC’s indicates hemolysis. My first guess would be HDN, but a direct coombs would be helpful. It could possibly be a genetic problem as others have suggested, Hereditary spherocytosis or G6PD. Thanks for interesting case.
Polychromasia, bite cells, spherocytes, NRBC, and normal platelets. (hemolytic anemia). Check for unconjugated bili. level, LDH, and Haptoglobin
R/O G6pd enzyme deficiency, and perform supravital stain for Heinz bodies.
Spherocytes, schistocytes and nrbcs present.
Perhaps ABO incompatibility?
Bite cells.
Hereditary stomatocytosis?
Glucose 6 phosphate dehydrogenase
(G-6-PD) deficiency?