An interesting case of atypical venous thrombosis with low red blood cells

Sex: F Age: 65 years. Recent abdominal colic. Petechial-like manifestations with painful discolored skin lesions (suggestive of dermal veins thromboses) on the chest and abdomen. Blood levels of glucose, electrolytes, amylase, lipase, total protein, renal-function tests, the prothrombin time, the international normalized ratio, the partial-thromboplastin time and albumin were normal. Laboratory testing revealed hemolytic anemia: red cells 2.94 x10(6)/UL; hemoglobin 8.9 g/dL; lactate dehydrogenase 950 IU/L. Computed tomography of the abdomen and pelvis performed after the administration of intravenous contrast material, revealed a central filling defect in the hepatic veins and their branches that was compatible with acute thrombosis of the hepatic veins and their branches. It was suspected paroxysmal nocturnal hemoglobinuria for which flow cytometric analysis was requested.