Transfusion Medicine Case 29 May 3, 2023 pathadmin 15 Comments 1. Presented by Eric A. Gehrie, MD and prepared by Lorraine N. Blagg, MA, MLS(ASCP)SBBClinical VignetteA school aged child presented to the emergency department with dark urine and recent history of pneumonia which had been treated with acetaminophen, cefdinir, and ceftriaxone. The patient's urinalysis showed a 2+ with protein and a large amount of blood with six RBCs per high power field. The urine culture showed no growth. The hemoglobin was 10.3 g/dL, with a hematocrit 28.1%, a total bilirubin of 2.5 mg/dL, and a haptoglobin of <6 mg/dL. The patient's sample was initially too hemolyzed to analyze for lactate dehydrogenase (LDH) or creatine kinase (CK) but was repeated on a new sample with a LDH result of 1457 U/L and a CK of 2550 U/L. A direct antiglobulin test (DAT), serologic drug study and Donath-Landsteiner tests were ordered.Direct Antiglobulin Test (DAT) Battery:Serologic Drug study:Donath-Landsteiner Test:Question:What is the most likely explanation of the patient's results?Drug induced hemolytic anemia Cold agglutinin diseaseParoxysmal nocturnal hemoglobinuria Paroxysmal cold hemoglobinuria Loading...
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