PMC6390241_01
Peripheral blood smear (1000x oil, magnification): normocytic normochromic anemia with mild anisopoikilocytosis and three erythrocytes (black circles) with Howell-Jolly bodies (nuclear remnants) and adequate numbers of appropriately granulated platelets.
CRIHEM2019-3146965.001.jpg
PMC6390241_01_CRIHEM2019-3146965.001.jpg
fig1
On the current admission, peripheral blood smear demonstrated the presence of numerous Howell-Jolly bodies (Figure 1), Pappenheimer bodies, acanthocytes, and target cells.
Splenic ultrasound. (a) Transverse dimension: 3.3 centimeters. (b) Long axis: 7.9 centimeters and anteroposterior: 3.9 centimeters. Atrophic spleen suggestive of multiple repeated episodes of infarction.
CRIHEM2019-3146965.002.jpg
PMC6390241_01_CRIHEM2019-3146965.002.jpg
fig2
Splenic sonogram now showed multifocal scarring and splenic atrophy, measuring 7.9 x 3.9 x 3.3 cm, suggestive of recurrent infarctions (Figure 2).
(a) CT showing atrophic spleen without the presence of calcification. (b) Liver-splenic scintigraphy demonstrating hepatic uptake of radioactive 99mTc-labelled colloid but absent splenic uptake.
CRIHEM2019-3146965.003.jpg
PMC6390241_01_CRIHEM2019-3146965.003.jpg
fig3
Liver-splenic scintigraphy with 99mTc-labelled colloid did not show splenic uptake, consistent with AS (Figure 3).