(Click the link to comment and to vote – voting not working through email, sorry!)
You are seeing a 5-year-old girl of Middle Eastern heritage who presents with 3 days of fever, fatigue, nausea, and tea-colored urine. Her vital signs are: temp 38.1, HR 110, RR 20, BP 85/35, pulse ox 98% on room air. Physical exam is notable for pallor and icterus. She has no past medical history and has been healthy. She has no recent travel nor pets. No one else in her family is sick. Her labs show a WBC of 10.2, Hgb 6.1, retic count 9%, bilirubin 11.0, and her smear shows normocytic, normochromic RBCs, blister cells, and a few bite cells. Electrolytes, LFTs, BUN, and Creatinine are normal.
Loading ...
January 29, 2026 at 12:05 pm
B) Eating a traditional meal of baghali ghatogh for the first time
Baghali ghatogh is made of fava beans, and the patient presentation is consistent with acute hemolytic anemia from G6PD-deficiency. G6PD deficiency is X-linked and more common in those of Mediterranean and Asian descent. The G6PD enzyme is key to the hexose monophosphate (HMP) shunt pathway, which protects RBC’s against oxidative injury. Exposure to foods, drugs, infections, chemicals that oxidize sulfhydryl groups on hemoglobin leads to acute hemolytic anemia episodes. Paroxysmal cold hemoglobinuria (much more rare) can similarly cause acute hemolysis after cold exposure, but typically stops once the patient is no longer exposed to cold. The smear did not show sickle cells. Hemolytic uremic syndrome occurs due to infection with shiga-toxin producing organisms such as E Coli from undercooked beef and can cause hemolytic anemia with schistocytes and helmet cells. However, no mention was made of a diarrheal prodrome, and there is no evidence of kidney injury or hypertension, which arer often seen with HUS. Post-strep glomerulonephritis can cause tea-colored urine but this is due to hematuria, not hemolytic anemia.