Correct!
5. All of the above
The total bilirubin is increased while the direct bilirubin is minimally elevated. Therefore, the indirect (unconjugated) must be elevated. In the absence of bruising or bleeding into a body organ the most common cause would be hemolytic anemia (1). The elevated serum LDH is consistent with LDH released from red blood cells in a hemolytic anemia. Additional laboratory testing of a complete blood count, reticulocyte count and serum haptoglobin would confirm the diagnosis. The diagnostic work-up done while the patient was in the emergency department was showed a hemoglobin of 8.1 g/dL (normal 12.0 to 15.5 g/dL), a hematocrit of 24.1 (normal 35.5 to 44.9), a mean corpuscular volume (MCV) of 96.7, and a platelet count of 24 x103/mcL (normal 150,000-300,000 cells/mcL). The reticulocyte was increased at 9.4% and the serum haptoglobin was decreased at <30/mg/dL consistent with haptoglobin binding to hemoglobin released during hemolysis. Prothrombin time (PT), partial thromboplastin time (PTT), creatinine and blood urea nitrogen (BUN) were all normal.
The patient was admitted with an initial diagnosis of hemolytic anemia and transient aphasia of unclear etiology.
What imaging studies should be ordered? (click on the correct answer to be directed to the fourth of eight pages)