Approach to anemia (destruction and sequestration) Quiz: Ace Your Exams

A 27-year-old man presents to the clinic with a 1-day history of abdominal pain, fatigue, and pallor. He reports that he recently developed a cough and congestion and used the remainder of his girlfriend’s antibiotics which helped with his symptoms. He recalls that his mother and younger brother occasionally have had “yellow eyes” when they have had infections. Past medical history is unremarkable. Temperature is 36.8°C (98.2°F), blood pressure is 125/75 mm Hg, pulse is 110/min, respiratory rate is 16/min, and oxygen saturation is 99% on room air. On exam, the conjunctivae are pale, and the sclerae have a slight yellowish tint. Abdominal examination is significant for diffuse abdominal tenderness, and mild splenomegaly. Laboratory evaluation is shown below. Peripheral blood smear shows Heinz bodies and Coombs test is negative. Which of the following is the most likely underlying cause for this patient’s presentation?  

Laboratory test	Results	Reference
Hemoglobin (Hb)	9.2 g/dL	13.5-17.5 g/dL
Hematocrit (Hct)	26%	41-53%
White Blood Cells (WBC)	7,500/mm3	4,500-11,000/mm3
Platelets (Plt)	300,000/mm3	150,000-400,000/mm3
Reticulocyte Count	10%	0.5-1.5%
Mean Corpuscular Volume (MCV)	88 fL	80-100 fL
Total Bilirubin	2.9 mg/dL	0.1-1.0 mg/dL
Direct Bilirubin	0.4 mg/dL	0.0 - 0.3 mg /dL
Lactate dehydrogenase (LDH)	360 U/L	45-90 U/L