Painful 2

A 10 year old girl presents with fever, vomiting, and mild generalized abdominal pain for 3 days. No other symptoms were present.

Her medical, surgical, family, and birth histories are unremarkable, while her growth and development have been normal so far. She is on a standard adult diet.

A complete blood count is significant for a Hb of 3.1 g/dL, MCV of 131 fL, and reticulocyte count of 10%. A liver profile reveals a serum bilirubin level of 5.1 mg/dL, with direct bilirubin amounting to 1.2 mg/dL.

Select Relevant Investigations
Peripheral Blood Film

Performed

The peripheral blood film reveals the presence of macrocytosis, polychromasia, anisocytosis, and microspherocytosis.
LDH + Urine Urobilinogen

Performed

Lactate Dehydrogenase (LDH): 521 IU/L (105-333)
Urine Urobilinogen: 14 mg/dL (0-8)
Direct Antibody Test

Performed

- Strongly Positive for IgG
- Negative for C3d
Indirect Antibody Test

Performed

- Positive at 37 °C
- Negative at 4 °C

Select Relevant Management
Blood Transfusion
Azathioprine
Rituximab
Folic Acid