This picture
appeared in the Facebook Hematology Interest Group today
“5 y-o child of Filipino background.
WBC: 13.0 G/L (corrected for NRBC)
Hgb: 81 g/L
MCV: 65 fL
Plt: 400 G/L
NRBC: 2/100 WBC
Retic: 650 G/L (RF: 40-120)”
My first
thought of some horrible acquired condition was revisited when I saw the child’s
age. Hereditary spherocytosis? Looks rather extreme…
Between seeing
the case and my actually writing this, the following appeared:
“24 hr incubated Osmotic Fragility is
abnormal.
Pathologist's review and comments:
"Prominent spherocytosis and reticulocytosis with abnormal increased 24 h
incubated osmotic fragility c/w Hereditary Spherocytosis, query autosomal
recessive. Less likely Hereditary Pyropoikilocytosis in view of Filipino
(non-black) background and lack of elliptocytosis in parents." Spectrin
analysis and heat stability tests were sent out to a reference lab. Results are
not available.”
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