case_images: PMC9198317_01
case_images: (A) Ektacytometry before and after splenectomy. (B) Eosin 5-Maleimide (EMA) binding assay two months prior to splenectomy (top curve) and two months post splenectomy (bottom curve). (C) Hemoglobin (g/dL), bilirubin (mg/dL), and reticulocytes (103/mm3) before and after laparoscopic splenectomy (day 0). Blood transfusions with one or two units of blood were given on day -955, -948, and -832. (D) Development in the proportion of erythrocytes expressing low or normal levels of EMA binding.
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case_images: Osmotic gradient ektacytometry was initially negative for hereditary spherocytosis (Fig. 1A) and the small pathological erythrocyte population on the EMA-binding test was initially discarded by the laboratory as an artefact (Fig. 1B). Repeated EMA-binding tests exposed two different erythrocyte populations, whereof one indicated spherocytosis (Fig. 1B). This resulted in reduced hemolysis with normalization of hemoglobin levels around 13.1 g/dL and bilirubin levels around 2.3 mg/dL (Fig. 1C).
case_images: Peripheral blood smear with spherocytes acquired with a CellaVision DM1200 analyzer.
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case_images: Careful examination of the peripheral blood smear (Fig. 2) revealed numerous spherocytes.