A CBC shows elliptocytes. Direct antiglobulin test is negative. Osmotic fragility is negative. Which diagnosis is most likely?

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Multiple Choice

A CBC shows elliptocytes. Direct antiglobulin test is negative. Osmotic fragility is negative. Which diagnosis is most likely?

Elliptocytes point to a red blood cell membrane skeleton defect. When the direct antiglobulin test is negative, autoimmune hemolysis is unlikely, and a membrane-related cause is more likely. A normal osmotic fragility test argues against hereditary spherocytosis, which typically shows increased fragility. Iron deficiency and sideroblastic anemia do not characteristically produce elliptocytes on the smear. Putting this together, hereditary elliptocytosis fits best: a genetic defect in membrane proteins (like spectrin or ankyrin) that yields elliptically shaped red cells, often with mild hemolysis and a negative DAT.

Elliptocytes point to a red blood cell membrane skeleton defect. When the direct antiglobulin test is negative, autoimmune hemolysis is unlikely, and a membrane-related cause is more likely. A normal osmotic fragility test argues against hereditary spherocytosis, which typically shows increased fragility. Iron deficiency and sideroblastic anemia do not characteristically produce elliptocytes on the smear. Putting this together, hereditary elliptocytosis fits best: a genetic defect in membrane proteins (like spectrin or ankyrin) that yields elliptically shaped red cells, often with mild hemolysis and a negative DAT.

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