PMC9751407_01
Hematologic parameters during the clinical course. RBC, red blood cells; PMN, polymorphonucleates; Peg, pegcetacoplan; Ecu, eculizumab.
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In 2016 an isolated moderate LDH increase (i.e. 1.6x ULN) occurred, and was later accompanied by mild unconjugated hyperbilirubinemia and progressive decrease of Hb values ( Figure 1 ).
Erythrocyte morphology and ektacytometry before and after pegcetacoplan treatment.
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Serial DAT evaluations at 1, 3, and 6 weeks after pegcetacoplan start, confirmed negativity of C3 deposition on patient's RBCs.  Figure 2  shows sequential peripheral blood smear morphology with the persistence of ovalocytes, spherocytes, dacrocytes, and stomatocytes before and after treatment, consistent with the underlying diagnosis of MPN. Notably, pre-treatment osmoscan curve showed a slight right shift, as observed in cases of overhydrated RBC; after the 1st and subsequent doses of pegcetacoplan, the right shift further increased (Ohyper values from 431 mOsm/kg pre-treatment to 450, 463, and 453, at the 3nd, 5th, and 7th dose, respectively,  Figure 2 ).