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24th July 2024
A 21-year-old female presents to A&E with intermittent episodes of passing dark urine
A 21-year-old female presents to A&E with intermittent episodes of passing dark urine. She is currently recovering from infectious mononucleosis after having tested positive at her GP around a week ago. She has noticed that the episodes of dark urine usually occur after she has been out for walks in the evenings and feeling cold. On examination, her sclera are icteric but there are no other abnormalities.
Her bloods show:
| Hb (115 – 165 g/L) | 107 g/L |
| WCC (3.6 – 11.0 x 10⁹/L) | 6.2 x10⁹/L |
| Platelets (140 – 400 x10⁹/L) | 205 x10⁹/L |
| Bilirubin (<21 μmol/L) | 47 µmol/L |
| ALT (<41 U/L) | 31 U/L |
| ALP (30–130 U/L) | 87 U/L |
| Film | Mild spherocytosis |
What would be the most appropriate next investigation to find the cause of these symptoms?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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