Hematology Morphology Forum

Abstract

A 24 year old male presented with 3 days fever, chills, jaundice and weakness. The patient was conscious, with stable vital signs. He had moderate pallor, icterus, no lymphadenopathy or organomegaly. Other systemic review was normal. Investigations showed Hb 3.6 gm/dl, PCV 0.95 l/l, MCV 82 fl, MCH 33.2 pg, RDW 14.4%, WBC 7.8 £ 10 /l, lymphocytes 1.1 £ 10 /l, monocytes 0.27 £ 10 /l, neutrophils 5.3 £ 10 /l, platelet count 112 £ 10 /l, reticulocyte count 3.5%. The peripheral blood film showed anaemia and autoagglutination of red cells. There was erythrophagocytosis by the neutrophils as illustrated in Fig. 1 and significant red cell rosetting around neutrophils as seen in Fig. 2. Urine examination was positive for haemoglobin. Liver function test were normal except for a total bilirubin 9.8 mg/dl, direct bilirubin 0.4 mg/dl. Blood bank serology showed haemolysis in the serum, positive autocontrol, negative Direct Coomb’s test and Indirect Coomb’s test. The Donath Landsteiner antibody was demonstrable in patient’s serum. Bone marrow was not diagnostic. Tests for syphilis, retroviral studies, Hepatitis B surface antigen, HCV, Dengue, mycoplasma and infectious mononucleosis were negative.