A 90-year-old female, with colon cancer, presented with fever with cough with dyspnea on exertion for 4 days. She was thoroughly investigated and subsequently diagnosed as community-acquired pneumonia with acute anemia. The peripheral blood smear (PBS) was evaluated and the result was shown above. 

Questions 

1. Please describe the PBS findings

2. Please give the complete list of differential diagnosis and tell the most likely cause of acute anemia in this patient? 

โดย นพ.ปฐมภูมิ คูอนุพงศ์ และ นพ.วิษณุพงศ์ ลอยเมฆ

ANSWERs

1.PBS findings

• RBC
  • Normochromic normocytic RBCs
  • Anisopoikilocytosis 2+, schistocytes 2+, echinocytes 1+
• WBC
  • Normal with PMN predominate 
• Platelets
  • Adequate (12/OF)

2.Diagnosis:  MAHA blood picture without thrombocytopenia

• Differential diagnosis
  • Sepsis with early DIC
  • Atypical HUS secondary from S.pneumoniae, Influenza pneumonia
  • Chronic DIC from malignancy
• The most likely caused of anemia in this patient:  atypical HUS secondary from S.pneumoniae, Influenza pneumonia

เรียบเรียงโดย นพ.ภูนรินทร์ ชุมสาย ณ อยุธยา แพทย์ประจำบ้านชั้นปีที่ 2 กองอายุรกรรม รพ.ภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ