What to look for: Patient with jaundice, African-American, dark colored urine, fatigue, history or blood disorder in the family, icterus on eye, pallor appearance, and possible use of TMP-SMX or other sulfa drugs
Patient should be hemodynamically stable so do a Complete Exam
Results of PE: Icterus on sclera, pallor appearance
- Hemoglobin and Hematocrit is abnormally low
- CBC will show normochromic normocytic erythrocytes
- Peripheral blood smear will show bite cells
- Serum Alkaline Phosphatase will be a little bit abnormally high
- Total bilirubin high, direct bilirubin is very low, so indirect bilirubin will be very high; pointing to intravascular hemolysis
- No fever or abdominal pain so hepatitis and acute cholangitis. No tenderness on palpation rules out liver and biliary tract pathology.
- UA will be normal
- LDH -> very high
- Haptoglobin -> low
- G6PD Levels are low; levels can be normal during or immediately after the acute hemolytic episode; so the test can be repeated
The primary goal is to stop the drug exposure and to provide supportive therapy.