Lacking

A 41 year old African American woman presents with abdominal pain, jaundice and dark urine for 3 days. She had experienced several bouts of vomiting since the previous day.

On the day her symptoms began, she had a dish of broad beans for breakfast.

Her medical and family histories are unremarkable. She underwent cholecystectomy at the age of 38. Her travel history is significant for a trip to Congo 5 months ago, where she stayed for 2 weeks.

Currently she is not on any medication. She only drinks socially, and does not have a history of IV drug abuse or sexual promiscuity.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 9.1×10^9/L (4-11×10^9)
N: 59% (50-70)
L: 35% (20-40)
Hb: 5.8 g/dL (11.5-13.5)
RBC: 1.9×10^12/L (4.0-5.4×10^12)
MCV: 105 fL
Reticulocytes: 7% (0.2- 2)
Platelets: 190 × 10^9/L (150- 400 × 10^9)
Peripheral Blood Smear

Performed

There are numerous blister and bite cells along with polychromasia and nucleated red blood cells; special preparation with supravital staining demonstrates Heinz bodies
Liver Profile

Performed

AST: 22 U/L (<35)
ALT: 16 U/L (<35)
ALP: 68 U/L (40-125)
GGT: 25 U/L (5-55)
Total Serum Bilirubin: 2.1 mg/dL (0.2-1.2)
Direct Bilirubin: 0.3 mg/dL (0.1-0.4)
Renal Function Tests

Performed

Serum Creatinine: 0.8 mg/dL (0.6-1.2)
Estimated Glomerular Filtration Rate (eGFR): 96 ml/min/1.73m2 (>90)
Blood Urea Nitrogen: 16 mg/dL (7-20)

Select Relevant Management
Iron Supplementation
Folic Acid supplementation
Aspirin
Antimalarial drugs