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5th February 2024
This is a 65-year-old Caucasian man who presented to A&E with a 3-day history of generalised abdominal pain, nausea, brown urine, jaundice and fever.
This is a 65-year-old Caucasian man who presented to A&E with a 3-day history of generalised abdominal pain, nausea, brown urine, jaundice and fever. He has a background history of oesophageal varices. On examination, there was no organomegaly. Blood test results were as follows:
| Parameter | Result | Normal range |
|---|---|---|
| Haemoglobin (g/dL) | 8.4 | 14.0-17.5 |
| Total leucocyte count (x109/L) | 19.02 | 4.4-11.3 |
| Differential leucocyte count (%) | ||
| Neutrophils | 70.5 | 50-70 |
| Lymphocytes | 15.2 | 25-40 |
| Monocytes | 13.0 | 2-8 |
| Eosinophils | 0.2 | 1-4 |
| Platelet count (x109/L) | 230 | 150-450 |
| Lactate dehydrogenase (U/L) | 1800 | <250 |
| Total bilirubin (mg/dL) | 11.2 | 0.3-1.2 |
| Direct bilirubin (mg/dL) | 0.85 | <0.2 |
| Creatine Kinase (U/L) | 452 | <271 |
| INR | 1.27 | – |
| Fibrinogen (mg/dL) | 255 | 200-400 |
Urinalysis showed bilirubinaemia and haemoglobinuria.
There was elevated reticulocyte count, low levels of haptoglobin and folic acid deficiency. The Coombs test was negative.
Which of the following is a likely trigger for this presentation?
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