Thread by @HermelinMD

24 y/o w/ h/o of Crohn’s Disease presents w/ worsening fatigue, weakness & dizziness. He has mild abdominal pain, but no signs of bleeding. No transfusion history. Infliximab was discontinued for autoimmune hepatitis. Hb/Hct = 4.4/13.5. 👇🏽Check out his peripheral smear below.

🤨Since you are the Heme/Onc Fellow on-call, you are 📟paged to consult on this patient’s anemia. What are the first labs you would order to assess #hemolysis?
#Blooducation #BBRounds #PathTweetorial

🔎When suspecting a hemolytic anemia, 4 hemolytic indexes can help you quickly determine the etiology of the patient's bleeding.
📰🧪Our patient’s lab results: LDH= 408, Hapto<8, IndBili =3.8 %Retic >30% which indicate a hemolytic anemia with adequate bone marrow response.

🤬The clinical team wants to transfuse the patient NOW! A type and screen was ordered. 👇🏽Check out the results of the Ab panel below and notice the panagluttinin pattern (2+ reactivity on cells).
⁉️What next test should be ordered? (Hint-rhymes w/ 🧹Brooms) ⌨️respond below!

🙌🏽You got it. The next test would be a Direct Antiglobulin Test (DAT) /Direct Coombs' Test which detects if Ab is coating the patient’s RBCs. In our patient’s case, his DAT is ➕ for IgG(4+). 💡Keep in mind, that strength of reactivity usually correlates w/ degree of hemolysis.

🤔What is your current working diagnosis?
#blooducation #BBRounds

Clinical history along w/ the peripheral smear (anemia w/ polychromatophilia, ⬆️ nRBCs and presence of ⓢⓟⓗⓔⓡⓞⓒⓨⓣⓔⓢ) & blood bank findings (panagluttinin w/ positive DAT, IgG) point to a warm autoimmune hemolytic anemia.
⁉️Can we find compatible blood for this patient?

Given the presence of the patient’s warm autoantibody, finding serologically compatible red cells may not be possible. As such, units will be issued with an 𝓔𝓶𝓮𝓻𝓰𝓮𝓷𝓬𝔂 𝓑𝓵𝓸𝓸𝓭 𝓡𝓮𝓵𝓮𝓪𝓼𝓮 form.
Keep Calm and Transfuse On 🅰️🅱️🆎🅾️!

To learn more about autoimmune hemolytic anemias, read this great review article by Dr. Michel 📰👉🏽doi-org.ezp.slu.edu/10.1586/ehm.11….
Any additional pearls, resources and experiences? Please add to the conversation below! Thank you

👍🏽Great explanation on 🧮calculating a reticulocyte count in an anemic patient. This is important to help determine if bone marrow response. ➡️

https://twitter.com/fernandbteich/status/1189591650441531395?s=20