Had an interesting case this month that my Blood Bank team was involved with. I've changed some of the information to protect her privacy.
A 21-year-old female presented with a 5 week history of fatigue, anorexia, and mild jaundice. She was previously healthy with no past medical history, no medications, and no drug use. The initial workup showed a normochromic, normocytic anemia (Hgb 11.5) and increased liver function tests and was negative for infectious mononucleosis and viral hepatitis. Just a few days after this basic workup her course worsened and she became more severely jaundiced and developed dark urine and right upper quadrant pain. She was admitted to a referring institution and the workup showed the following:
Afebrile and vital signs stable
Scleral icterus, jaundice, splenomegaly, and RUQ pain on exam
WBC: 13.5 H
Hgb: 6.5 L
Plt: 178
Creatinine: 2.2 H
ALT: 13
AST: 147 H
Alk phos: 17 L
Tbili: 42.9 H
Dbili: 12.6 H
INR: 3.1 H
Albumin: 2.3 L
LDH: 659 H
Haptoglobin: undetectable L
Retic: 11.79 H
Direct antiglobulin: neg.
Blood type: O+, Ab screen neg.
ANA: within normal limits
Serum pregnancy test: neg.
Does anyone have a diagnosis? I'll post it in a week with follow up photos in a new post and/or comment.
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