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Annals of Clinical Biochemistry

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This version was published on 1 July 2009
Ann Clin Biochem 2009;46:341-343
doi:10.1258/acb.2009.008190
© 2009 Association for Clinical Biochemistry

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Case Report

Delayed appearance of markers of intravascular haemolysis in a case of paroxysmal cold haemoglobinuria

Sally D Slack1, Paul Laboi2, Martin R Howard3 and Ahmed A Waise1


1 Department of Clinical Biochemistry; 2 Department of Medicine; 3 Department of Haematology, York Hospital, Wigginton Road, York YO31 8HE, UK


Corresponding author: Sally D Slack. Email: sally.slack{at}york.nhs.uk

The aetiology of haemolytic disease is diverse and the diagnosis often relies on laboratory testing. We describe a case of intravascular haemolysis, which illustrates that significant intravascular haemolysis can occur in the absence of any abnormal haematological findings. Despite gross haemoglobinuria at presentation, the haemoglobin and reticulocyte counts were both within reference limits and a normal blood film was observed. Subsequently, acute tubular necrosis occurred secondary to haemolysis, and acute renal failure was evident by day 2. However, the haemoglobin decreased slowly reaching a nadir of 75 g/L on day 6 (reference interval 130–180 g/L). A diagnosis of paroxysmal cold haemoglobinuria secondary to mycoplasma infection was subsequently made. Biochemical analysis was useful in this case to confirm that the gross pigmentation in the samples received could be attributable to intravascular haemolysis.


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