Question

An elderly patient presents with anemia and hemoglobinuria. Investigations reveal increased lactate dehydrogenase (LDH). The peripheral smear image is given below. Which of the following physical examination findings can support the likely diagnosis?

• A. Splenomegaly
• B. Frontal bossing
• C. Mechanical second heart sound
• D. Goitre

Answer 1

The Correct Option is A

An elderly patient with anemia, hemoglobinuria, and elevated lactate dehydrogenase (LDH) is likely suffering from a hemolytic anemia condition. Hemolytic anemia is characterized by the destruction of red blood cells (hemolysis), leading to the release of hemoglobin into the blood, which can cause hemoglobinuria. One of the common types of hemolytic anemia is due to the presence of conditions such as hereditary spherocytosis or autoimmune hemolytic anemia, where extravascular hemolysis is predominant. 

The peripheral smear, although not visible here, would typically show spherocytes or fragmented red cells in such conditions, hinting towards a hemolytic process.

The physical examination finding that often accompanies these conditions is splenomegaly (enlargement of the spleen). The reason for splenomegaly is that the spleen is involved in filtering and destroying defective or antibody-coated red blood cells, which is enhanced in hemolytic anemias leading to its enlargement.

Other options such as frontal bossing, mechanical second heart sound, and goitre are not directly related to hemolytic anemia.

Therefore, the likely physical examination finding that supports the diagnosis of hemolytic anemia in this clinical scenario is splenomegaly.