The Clinical Problem Solvers Episode 427: Schema Episode – Schistocytes
Oct 30, 2025
A riveting case unfolds with a 65-year-old patient presenting severe dyspnea and anemia. The hosts dissect the diagnostic challenge of schistocytes and pinpoint their role in hemolysis. They navigate through critical lab findings and imaging, uncovering a potential malignancy linked to the patient's condition. Insights on the relationship between adenocarcinoma and hemolytic anemia provide a deeper understanding of marrow infiltration. The case culminates in a treatment response, emphasizing the importance of early diagnosis and lab sensitivity.
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Case Start: Progressive Exertional Dyspnea
- Yusuf presented a 65-year-old man with weeks of progressive exertional dyspnea and palpitations.
- The team used the dyspnea pyramid to prioritize cardiopulmonary causes and anemia.
Prioritize Heart, Lungs, And Blood
- Prioritize cardiopulmonary causes and anemia first when evaluating dyspnea.
- Obtain EKG and oxygen saturation early and consider anemia as a reversible cause of exertional dyspnea.
Send A Focused Hemolysis Panel Immediately
- In suspected hemolysis, send LDH, haptoglobin, reticulocyte count, iron studies and a peripheral smear promptly.
- Also order DIC labs and a smear early to rule out emergency causes like thrombotic microangiopathy.
