Intravascular haemolysis: a potential missed diagnosis.
Raised serum bilirubin is a common finding as part of a routine "liver function test" profile. This case describes a patient with a raised serum bilirubin that was eventually found to be caused by intravascular haemolysis. The tests that confirmed the cause were instigated by clinical biochemistry staff but not before the patient had undergone unnecessary invasive procedures and had the diagnosis delayed by some time. The case is a reminder to biochemistry and haematology laboratories and clinical staff to investigate the possibility of haemolysis as well as hepatitis and Gilbert's disease as a cause of an isolated raised bilirubin.
Sinclair
David
D
Department of Chemical Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom. david.sinclair@porthosp.nhs.uk
Briston
Philip
P
Rutland
Emma
E
D000368:Aged; D000743:Anemia, Hemolytic / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005878:Gilbert Disease / Q000175:diagnosis; D006461:Hemolysis; D006505:Hepatitis / Q000175:diagnosis; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology*