A case of severe anemia of mixed genesis is presented. The clinical picture of the disease is described, the data of laboratory investigations are given. The interest of this case for attending physicians and employees of clinical diagnostic laboratories (CDL) is due to significant discrepancies between the results of blood analysis according to automatic analysis performed using a hematology analyzer and the data of light microscopy of a stained blood smear. Various morphological changes were found in the stained blood smear, which contradicted relatively normal erythrocyte parameters (MСV, MСН, RDW) and the absence of any flags according to the hematological analyzer. The problems of using hematological analyzer data as a basis for differential diagnosis of anemia with various disorders of erythrocyte and leukocyte morphology, especially when using artificial intelligence for decision-making, are discussed.
The presented case demonstrates the importance of a comprehensive analysis of all the examination data in a patient with paroxysmal nocturnal hemoglobinuria (PNH). A comparison was made of anamnesis data, the clinical picture of the disease, the results of biochemical blood analysis and hematological analyzer data with morphological assessment of cells in a stained blood smear. The interest of this case for hematologists and laboratory specialists is due to the rarity of this disease, difficulties in diagnostics, the presence of 2 types of hemolysis, features of morphological changes in peripheral blood erythrocytes, as well as analysis of the dynamics of manifestations, including against the background of targeted therapy of PNH.
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