This appeared
on the Facebook Hematology Interest Group today:
“An
8-year-old Chinese boy did not feel well and was given some herbal medicine to
relieve his condition. One day later, he got fever and jaundice, and passed
cola-coloured urine. He very pale and icteric although there was no organomegaly.
The following are some
routine laboratory results.
Hb 3.5 g/dL
Hct 0.11 L/L
Plt 211 × 10^9/L
WBC 28.3 × 10^9/L
Myelocytes 10%
Metamyelocytes 11%
Neutrophils 71%
Lymphocytes 7%
Eosinophils 1%
NRBCs 5/100WBC
Reticulocyte count
50.0%
Corrected reticulocyte
count 12.6%
Urea 49.6 mmol/L [NR:
5.4 – 16.1 mmol/L]
Creatinine 153 µmol/L
[NR: 53 – 115 µmol/L]
Bilirubin, total 221
µmol/L [NR: 9 – 24 µmol/L]
Bilirubin, direct 17
µmol/L [NR: 0 – 6.8 µmol/L]
LDH 5165 U/L [NR: 230 –
460 U/L] ”
An interesting discussion ensued. Clearly there
is a haemolytic process going on. But what’s causing the raised white cells
count?
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