Case 134

1. Prepared by Julia Gales, MD and reviewed by Herleen Rai, MD.

A child presents to an outside hospital following a finger fracture and development of dark “coca-cola” colored urine. A complete blood count (CBC) was concerning for anemia, while the urinalysis was positive for hemoglobin (Hb) pigment. Urology was concerned for a possible secondary hemolytic process. The decision was made to transfer the patient to JHH for further workup. Bloodwork and labs were repeated on admission. A peripheral blood smear showed anisocytosis and poikilocytosis, with the presence of were echinocytes, schistocytes, and spherocytes. Of note,  platelet clumps, giant thrombocytes, along with vacuolization of the granulocytes (neutrophils, monocytes, and bands) was present.

Laboratory Results on admission: 


Blood Bank Testing: 


The patient’s clinical presentation continued to deteriorate and the team continued to be concerned for an ongoing hemolytic process. Given the patient’s positive DAT results and clinical status, a Donath Landsteiner test was ordered.

Donath-Landsteiner Test 



Question:         What is true of this patient’s condition?