The results include LDH: 300 U/L; Bilirubin: NEG; Blood: 2+; Urobilinogen: 2 Ehrlich units. Which diagnosis is most likely?

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Multiple Choice

The results include LDH: 300 U/L; Bilirubin: NEG; Blood: 2+; Urobilinogen: 2 Ehrlich units. Which diagnosis is most likely?

RBC destruction drives this pattern. When red blood cells lyse, LDH is released from the cells, so a modestly elevated LDH level is common in hemolysis. The bilirubin result being negative in urine fits with a predominance of unconjugated bilirubin in the blood; unconjugated bilirubin is not water-soluble and does not appear in urine, even though the overall bilirubin turnover is increased. A 2+ finding for blood in the urine with no explicit mention of red blood cells on microscopy points to free hemoglobin in the urine from intravascular hemolysis, rather than intact RBCs. At the same time, urobilinogen in the urine is increased because more bilirubin is delivered to the gut and converted to urobilinogen, some of which is excreted in urine. Putting these clues together points to a hemolytic process, which can be caused by conditions like pernicious anemia or other forms of hemolytic anemia. The other listed diagnoses don’t typically produce this combination of elevated LDH with negative urinary bilirubin, hemoglobinuria, and increased urinary urobilinogen.

RBC destruction drives this pattern. When red blood cells lyse, LDH is released from the cells, so a modestly elevated LDH level is common in hemolysis. The bilirubin result being negative in urine fits with a predominance of unconjugated bilirubin in the blood; unconjugated bilirubin is not water-soluble and does not appear in urine, even though the overall bilirubin turnover is increased.

A 2+ finding for blood in the urine with no explicit mention of red blood cells on microscopy points to free hemoglobin in the urine from intravascular hemolysis, rather than intact RBCs. At the same time, urobilinogen in the urine is increased because more bilirubin is delivered to the gut and converted to urobilinogen, some of which is excreted in urine.

Putting these clues together points to a hemolytic process, which can be caused by conditions like pernicious anemia or other forms of hemolytic anemia. The other listed diagnoses don’t typically produce this combination of elevated LDH with negative urinary bilirubin, hemoglobinuria, and increased urinary urobilinogen.

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