Question

A healthy 39-year-old male of German descent comes for a routine exam. He had a cholecystectomy at 25 years old and has been experiencing mild spontaneously resolving jaundice over the past 10 years. He also has splenomegaly and a mean corpuscular volume (MCV) of 80. The Coombs test is negative, and peripheral blood smear (PBS) shows red blood cells (RBCs) with loss of central pallor. What is the most likely cause of the patient's anemia?

1) Iron deficiency anemia
2) Thalassemia
3) Sickle cell anemia
4) Hereditary spherocytosis

Answer 1

The most likely cause of the patient's anemia, based on the negative Coombs' test and peripheral blood smear findings, is hereditary spherocytosis.

Step-by-step explanation:

The most likely cause of a healthy 39-year-old male's anemia, who has been experiencing spontaneous jaundice and has splenomegaly and a mean corpuscular volume (MCV) of 80, a negative Coombs' test, and peripheral blood smear (PBS) showing red blood cells (RBCs) with loss of central pallor, is 4) Hereditary spherocytosis. This condition is characterized by the production of spherically shaped red blood cells that are more prone to rupture. The negative Coombs' test rules out immune-mediated hemolysis, while the characteristic blood smear findings align with hereditary spherocytosis. Furthermore, the lack of other symptoms also associated with thalassemia, sickle cell anemia, and iron deficiency anemia helps in excluding them as likely causes.