SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Anemia

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An 85-year-old man with myasthenia gravis presented after a fall with shortness of breath and back pain. He was found to have a new segmental pulmonary embolus and was started on heparin. During hospitalization, his hemoglobin fell from a baseline of 13 to 7.0, raising concern for bleeding related to anticoagulation or trauma. However, CT imaging showed no intrabdominal or retroperitoneal hemorrhage, and he denied any overt bleeding.<br /><br />A key clue was persistent indirect hyperbilirubinemia that had been present for two months. Hemolysis labs showed elevated LDH, low haptoglobin, increased reticulocytes, and a negative direct antiglobulin test. Peripheral smear demonstrated bite cells and Heinz bodies, consistent with oxidative hemolysis. Further review of his medications revealed that he had started dapsone two months earlier for Pneumocystis jirovecii pneumonia prophylaxis while on high-dose prednisone.<br /><br />He was diagnosed with Heinz body hemolytic anemia due to dapsone, likely worsened by underlying G6PD deficiency. His G6PD level returned normal, but this was thought to be falsely normal during acute hemolysis. Dapsone was stopped, and his hemoglobin improved along with normalization of hemolysis markers.<br /><br />This case highlights the importance of considering hemolysis when anemia worsens after anticoagulation is started, especially when bleeding is not found. A broad differential and attention to subtle lab abnormalities can prevent unnecessary invasive workup and lead to the correct diagnosis.

Asset Subtitle

Tyler Edwards

Meta Tag

Author List Tyler Edwards

Category Clinical Vignettes

Concept Heinz Body Hemolytic Anemia

Concept Dapsone

Concept Hemolysis

Concept Glucose-6-Phosphate Dehydrogenase Deficiency

Concept Anemia

Distinguished Non-Finalist

Presenter Organization Northwestern Medical Hospital

Presenting Author Tyler Edwards

Track Adult

Keywords

myasthenia gravis

pulmonary embolus

heparin

anemia

hemolysis

dapsone

Heinz bodies

bite cells

G6PD deficiency

indirect hyperbilirubinemia

Heinz Body Hemolytic Anemia

Dapsone

Hemolysis

Glucose-6-Phosphate Dehydrogenase Deficiency

Anemia