Question

An 18-year-old woman from Copenhagen, Denmark, has had malaise and a low-grade fever for the past week, along with arthralgias. On physical examination, she appears very pale, except for a bright red malar facial rash. She has a history of chronic anemia, and spherocytes are observed on a peripheral blood smear. Her hematocrit, which normally ranges from 35% to 38%, is now 28%, and the reticulocyte count is very low. The serum bilirubin level is 0.9 mg/dL. Which of the following events is most likely to have occurred in this patient?

Answer 1

Based on the information provided, the most likely event that has occurred in this patient is the development of autoimmune hemolytic anemia. Autoimmune hemolytic anemia is a type of anemia that occurs when the immune system mistakenly attacks and destroys red blood cells. Symptoms of autoimmune hemolytic anemia can include malaise, low-grade fever, arthralgias, and a characteristic facial rash called a "malar" or "butterfly" rash. Physical examination may reveal pale skin, spherocytes on a peripheral blood smear (which are red blood cells that are small and round), and a low hematocrit and reticulocyte count. The serum bilirubin level may also be elevated due to the increased destruction of red blood cells. Treatment of autoimmune hemolytic anemia may involve the use of immune-suppressing medications and/or blood transfusions.