The Golden Clue

🗒️ Question 

A 60 year old woman presents to the GP with progressive fatigue, jaundice and dark urine for the past week. She has a history of sickle cell trait, hypertension and type 2 diabetes mellitus.

She has no history of recent travel, new medications or significant changes in her diet. On examination, she is icteric with mild tenderness in the RUQ and a palpable spleen 2cm below the costal margin. Her observations are stable.

Blood tests reveal the following:

• Haemoglobin: 90 g/L (120-160 g/L)

• Reticulocyte count: 5% (0.5-2.5%)

• Total bilirubin: 68 µmol/L (3-17 µmol/L)

• AST: 45 U/L (10-40 U/L)

• ALT: 50 U/L (7-56 U/L)

• LDH: 600 U/L (135-225 U/L)

• Haptoglobin: undetectable

• G6PD level: normal

What is the most likely diagnosis?

(A) Sickle cell crisis
(B) Autoimmune haemolytic anaemia
(C) Wilson’s Disease
(D) Gilbert's syndrome
(E) Hereditary spherocytosis