Teaching Cases from the Royal Marsden and St Mary's Hospitals: Case 18: Severe Anaemia and Thrombocytopenia with Red Cell Fragmentation

Abstract

A 69 year old male presented with a four week history of exertional dyspnoea and easy fatiguability with two weeks of a flu like illness with productive cough. He was pale with petechial haemorrhages on his ankles and torso. Chest examination revealed crepitations in the right axillary region and bronchial breathing in both the lower and mid zones. There was no hepatosplenomegaly. He was apyrexial and had no neurological abnormalities. Results of biochemical tests were: serum creatinine 77 mol/l, sodium 134 mmols/l, potassium 3.8 mmols/l, LDH 917 U/l (normal range 150-450 U/l), bilirubin 14 mol/l. The results of a full blood count were WBC 7.1 X 10⁹/1, Hb 4.0 g/d1, MCV 91fl, platelets 44 × 10⁹/1 and reticulocyte count 37 X 10/1. The blood film confirmed the thrombocytopaenia and showed red cell fragments, acanthocytes and other poikilocytes (Fig. 1).