Case Reports in Hematology / 2019 / Article / Tab 1

Case Report

Diagnostic and Treatment Challenges of Paroxysmal Nocturnal Hemoglobinuria in Uganda

Table 1

Investigations.

Blood tests
YearTest nameResultsLab reference range

2012CBC
(1) WBC2.2 × 10⁹/L3.5–10.5 × 10⁹/L
(2) Hb3.4 g/dl13.5–17.5 g/dl
(3) MCV116 fl80–96 fl
(4) PLT123 × 10⁹/L150–450 × 10⁹/L
Reticulocyte10.6%0.5–2.5%
Peripheral smearPancytopenia, dimorphic, normocytic, and normochromic anemia
Serum B12 levels123.2 pmol/L141–698 pmol/L
Serum folate levels45.4 nmol/L10.4–59 nmol/L
AST2.35 ukat/L0.167–0.667 ukat/L
Bilirubin total26 µmol/L1.7–20.5 µmol/L
Bilirubin direct7 µmol/L5.1 µmol/L
Antiglobulin test (both direct and indirect)Negative
RDT for malariaNegative
Urine chemistryHemoglobin pigments
Sickling testNegative

2013CBC
(1) WBC2.6 × 10⁹/L3.5–10.5 × 10⁹/L
(2) Hb5 g/dl13.5–17.5 g/dl
(3) MCV101 fl80–96 fl
(4) PLT130 × 10⁹/L150–450 × 10⁹/L
Serum B12 levels991.6 pmol/L141–698 pmol/L
AST1.2 ukat/L0.167–0.667 ukat/L
Peripheral smearMacrocytosis
Bone marrow aspirate and biopsy reportErythropiosis: hyperplasia with megaloblastic maturation. No granulopoiesis: hyperplastic, left shift with giant metalocytes, and myeloblast <5%

2014AST2.29 ukat/L0.167–0.667 ukat/L
Bilirubin total43.2 µmol/L1.7–20.5 µmol/L
Bilirubin direct5.8 µmol/L5.1 µmol/L
LDH45.38 ukat/L2.67–7.5 ukat/L
Antiglobulin test (both direct and indirect)Negative
HBsAgNonreactive
Hepatitis C antibodiesNonreactive
HIV rapid testNonreactive
Urine chemistryHemoglobin pigments

2015Serum homocysteine levels21 µmol/L5–16 µmol/L
Urine methylmalonic acid0.0 mmol/mol crt0.0–3.6 mmol/mol crt

2016Serum B12 levels1475.6 pmol/L141–698 pmol/L

2018CBC
(1) WBC3.4 × 10⁹/L3.5–10.5 × 10⁹/L
(2) Hb3.5 g/dl13.5–17.5 g/dl
(3) MCV111 fl80–96 fl
(4) PLT120 × 10⁹/L150–450 × 10⁹/L
Abdominal ultrasound scanNormal
EchocardiographyDilated chambers of the heart with moderate tricuspid and mitral insufficiency. No features of pulmonary arterial hypertension

CBC, complete blood count; WBC, white blood count; Hb, hemoglobin; MCV, mean corpuscular volume; PLT, platelets; RDT, rapid diagnostic test; HBsAg, hepatitis B surface antigen; AST, leukocyte aspartate aminotransferase; LDH, lactate dehydrogenase.