A CBC is performed with Hgb 72 g/L, Hct 0.290/L, RBC 5.0 x 10^12/L, WBC 11.5 x 10^9/L, PLT 18 x 10^9/L, MCV 83 fL, MCH 28 pg, MCHC 340 g/L, RETIC 10%, Peripheral Smear: Schistocytes, helmet cells. Additional Testing: uBIL 45 μmol/L, LDH 800 U/L, Coagulation Studies: PT 12 sec, APTT 40 sec. What is the presumptive diagnosis?

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Multiple Choice

A CBC is performed with Hgb 72 g/L, Hct 0.290/L, RBC 5.0 x 10^12/L, WBC 11.5 x 10^9/L, PLT 18 x 10^9/L, MCV 83 fL, MCH 28 pg, MCHC 340 g/L, RETIC 10%, Peripheral Smear: Schistocytes, helmet cells. Additional Testing: uBIL 45 μmol/L, LDH 800 U/L, Coagulation Studies: PT 12 sec, APTT 40 sec. What is the presumptive diagnosis?

Schistocytes and helmet cells on the peripheral smear indicate mechanical destruction of red cells from intravascular microthrombi, i.e., microangiopathic hemolytic anemia (MAHA). The combination of MAHA with severe thrombocytopenia, reticulocytosis, elevated LDH, and increased unconjugated bilirubin, together with normal coagulation tests (PT and APTT), points to a thrombotic microangiopathy. This pattern is most consistent with thrombotic thrombocytopenic purpura, rather than isolated platelet destruction as seen in immune thrombocytopenia. HUS would typically show more renal involvement (kidney impairment), aplastic anemia would present with pancytopenia and hypocellular marrow, and immune thrombocytopenia would not feature MAHA with schistocytes.

Schistocytes and helmet cells on the peripheral smear indicate mechanical destruction of red cells from intravascular microthrombi, i.e., microangiopathic hemolytic anemia (MAHA). The combination of MAHA with severe thrombocytopenia, reticulocytosis, elevated LDH, and increased unconjugated bilirubin, together with normal coagulation tests (PT and APTT), points to a thrombotic microangiopathy. This pattern is most consistent with thrombotic thrombocytopenic purpura, rather than isolated platelet destruction as seen in immune thrombocytopenia. HUS would typically show more renal involvement (kidney impairment), aplastic anemia would present with pancytopenia and hypocellular marrow, and immune thrombocytopenia would not feature MAHA with schistocytes.

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