J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://www.thejh.org

Letter to the Editor

Volume 12, Number 4, August 2023, pages 197-200

Hemolytic Anemia Requiring Splenectomy in Leigh-Like Syndrome due to the Variant m.10191T>C in MT-ND3

Figure 1. (a) Micrograph of unstained peripheral blood viewed with compound light microscopy through 606 - 660 nm red filter, demonstrating unreported “clover” cells, two RBCs folded over one another (× 1,000, arrows). (b) Micrograph of eosin Y-stained peripheral blood viewed with compound light microscopy demonstrating dacrocytes (× 1,000, arrows). (c) Micrograph of peripheral blood smear stained with acridine orange, viewed under fluorescence with 450 - 490 nm IVFL epi-fluorescence condenser, demonstrating echinocytosis and scattered “target cells” (× 400, arrows). (d) Micrograph of unstained peripheral blood viewed with compound light microscopy demonstrating echinocytosis (× 1,000, arrows). RBC: red blood cell.

**Table 1.** Relevant Parameters of the Anemia Workups
Parameter	Reference ranges	08/2015	09/2015	10/2015	01/2016	02/2016	09/2016	10/2017	05/2018	10/2018	08/2021
^aFemale range. RBC: red blood cell; Hb: hemoglobin; HCT: hematocrit; MCH: mean corpuscular hemoglobin; RDW-SD: distribution width standard deviation; WBC: white blood cell; PLT: platelet; Bil: bilirubin; TIBC: total iron-binding capacity; LDH: lactate dehydrogenase; ESR: erythrocyte sedimentation rate.
RBC	3.92 - 5.13 × 10⁶/µL^a	-	2.83	-	2.58	2.26	3.23	4.04	4.42	4.6	3.85
Hb	12.1 - 15.1 g/dL^a	8.5	8.1	-	7.6	6.6	9.7	10.7	11.6	12.0	11.7
HCT	38-48%^a	26.7	26.7	-	23.0	20.2	31..3	33.5	-	-	35.7
MCH	27.5 - 33.2 pg	-	28.6	-	29.5	29.0	-	26.5	-	26.1	30.4
RDW-SD	36 - 47 fL	-	53.6	-	55.5	59.1	68.5	54.5	56.9	-	49.7
WBC	4.5 - 11.0 × 10³/µL	-	4.6	-	4.3	3.2	7.0	10.0	11.7	-	8.2
PLT	150 - 450 × 10³/µL	-	330	-	317	195	1,035	941	-	-	5.33
Bil	0.1 - 0.3 mg/dL	0.1	-	0.7	0.3	0.1	-	-	-	-	-
Retics	0.5-2.5%	1.4	-	-	-	1.4	-	-	-	-	-
Iron	60 - 16 µg/dL	-	-	-	-	48	-	-	32	60	-
TIBC	240 - 450 µg/dL	292	-	-	-	-	-	-	376	403	-
Ferritin	11 - 307 µg/L^a	-	-	-	-	96	-	-	-	-	-
Haptoglobin	43 - 165 mg/dL	-	-	< 10	-	12	233	-	283	-	-
B12	190 - 950 pg/mL	754	-	-	-	512	-	-	-	-	-
Folate	> 7.3 ng/mL	10.6	-	-	-	7.3	-	-	-	-	-
LDH	112 - 303 IU/L	-	-	-	116	-	98	-	113	-	-
ESR	1 - 20 mm/h	45	-	-	-	117	-	-	-	-	-

Table 1. Relevant Parameters of the Anemia Workups

Parameter

Reference ranges

08/2015

09/2015

10/2015

01/2016

02/2016

09/2016

10/2017

05/2018

10/2018

08/2021

^aFemale range. RBC: red blood cell; Hb: hemoglobin; HCT: hematocrit; MCH: mean corpuscular hemoglobin; RDW-SD: distribution width standard deviation; WBC: white blood cell; PLT: platelet; Bil: bilirubin; TIBC: total iron-binding capacity; LDH: lactate dehydrogenase; ESR: erythrocyte sedimentation rate.

RBC

3.92 - 5.13 × 10⁶/µL^a

2.83

2.58

2.26

3.23

4.04

4.42

4.6

3.85

12.1 - 15.1 g/dL^a

8.5

8.1

7.6

6.6

9.7

10.7

11.6

12.0

11.7

HCT

38-48%^a

26.7

23.0

20.2

31..3

33.5

35.7

MCH

27.5 - 33.2 pg

28.6

29.5

29.0

26.5

26.1

30.4

RDW-SD

36 - 47 fL

53.6

55.5

59.1

68.5

54.5

56.9

49.7

WBC

4.5 - 11.0 × 10³/µL

4.6

4.3

3.2

7.0

10.0

11.7

8.2

PLT

150 - 450 × 10³/µL

330

317

195

1,035

941

5.33

Bil

0.1 - 0.3 mg/dL

0.1

0.7

0.3

0.1

Retics

0.5-2.5%

1.4

Iron

60 - 16 µg/dL

TIBC

240 - 450 µg/dL

292

376

403

Ferritin

11 - 307 µg/L^a

Haptoglobin

43 - 165 mg/dL

< 10

233

283

B12

190 - 950 pg/mL

754

512

Folate

> 7.3 ng/mL

10.6

7.3

LDH

112 - 303 IU/L

116

113

ESR

1 - 20 mm/h

117