Required section · Section 4 of 6
Work the guided case
The case has anemia with reticulocytosis: 8.1% and an absolute reticulocyte count of 224 × 10^9/L. The cited Mayo adult interval is 0.60% to 2.71% and 30.4 to 110.9 × 10^9/L, but it is an example rather than a transferable local interval. Macrocytosis can accompany reticulocytosis in this pattern.
LDH is increased, bilirubin is indirect predominant because total bilirubin is 42 and direct bilirubin is 5 micromol/L, and haptoglobin is low. Urine blood is 2+ with few intact red cells on microscopy. Together these findings support increased red-cell destruction and favor an intravascular component.
The smear has polychromasia and spherocytes without increased schistocytes. The direct antiglobulin test (DAT) detects immunoglobulin or complement coating red cells; here the polyspecific DAT is positive 2+, with IgG 2+ and C3d negative by local column agglutination. Communicate the integrated pattern and route immunohematology follow-up under the local procedure.
Illustrative drawing — this picture was drawn rather than captured.
| Result | Value | Reference interval or context |
|---|---|---|
| Hemoglobin | 86 g/L | 120-160 g/L, local example |
| Reticulocytes | 8.1% | 0.60-2.71%, Mayo example only |
| Absolute reticulocytes | 224 × 10^9/L | 30.4-110.9 × 10^9/L, Mayo example only |
| LDH | 815 U/L | 120-246 U/L, local example |
| Total bilirubin | 42 micromol/L | 3-20 micromol/L, local example |
| Direct bilirubin | 5 micromol/L | 0-7 micromol/L, local example |
| Haptoglobin | less than 0.08 g/L | 0.30-2.00 g/L, local example |
| Urine blood pad | 2+ | Few intact RBCs on microscopy |
| DAT | IgG 2+, C3d negative | Local column agglutination |
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