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 http://www.thejh.org

Case Report

Volume 4, Number 3, September 2015, pages 205-209

A Case of Evans Syndrome: A Clinical Condition With Under-Recognized Thrombotic Risk

Figure

Figure 1. CT of abdomen/pelvis: filling defect/lack of opacification of the left common iliac, internal and external iliac with apparent compression of the left common iliac vein by the right common iliac artery. Findings are most consistent with May Thurner syndrome.

Tables

**Table 1.** Initial and Follow-Up Labs After 12-Weeks: CBC, Reticulocyte Count, Hemolysis Labs and ANA
Test	At presentation	12-week follow-up	Reference
White blood cells	25.9	3.9	4.40 - 11.30 × 10³/μL
Red blood cells	2.9	4.5	4.50 - 5.10 m/μL
Hemoglobin	9.0	13.2	12.3 - 15.3 g/dL
Hematocrit	28.0	41.2	36.0-45.0%
MCV	97.2	91.4	80.0 - 96.0 fL
MCH	31.3	29.3	27.5 - 33.2 pg
MCHC	32.1	32.0	33.4 - 35.5 g/dL
RDW	21.9	16.0	11.3-15.3%
Platelet count	45.0	201.0	145 - 445 × 10³/μL
RBC morphology	Abnormal	Abnormal
Howell-Jolly bodies	Moderate
Macrocytosis	Moderate
Polychromasia	Moderate
Reticulocytes percent	8.7	0.9	0.50-2.00%
Reticulocytes absolute	0.2	0.0	0.020 - 0.140 m/μL
LDH	467.0	198.0	110 - 216 U/L
Haptoglobin	35.8	150.4	16 - 200 mg/dL
Bilirubin direct	0.3	0.4	0.0 - 0.4 mg/dL
DAT	Positive
ANA, IFA	1:320		< 1:80
	Diffuse homogenous

**Table 2.** Initial and 12-Week Follow-Up APLA Testing
Test	At presentation	12-week follow-up	Reference
Fibrinogen level	189.0		212 - 479 mg/dL
Fibrin degradation products	160 to 320		< 5 μg/mL
Diluted viper venom ratio	1.7	2.2	1.3 ratio
Diluted viper venom confirmation ratio	1.5	1.7	1.3 ratio
PTT without hexagonal phospholipids	50.0	74.8	27 - 35 s
PTT with hexagonal phospholipids	37.0	49.9	27 - 35 s
Interpretation LA	Positive	Positive
Anticardiolipin, IgG	16.0	31.0	0 - 34 GPL
Anticardiolipin, IgA	25.0	20.0	0 - 20 APL
Anticardiolipin, IgM	12.0	13.0	0 - 12 MPL
B2 glycoprotein I, IgG	42.0	80.0	0 - 12 SGU
B2 glycoprotein I, IgA	112.0	104.0	0 - 19 SAU
B2 glycoprotein I, IgM	40.0	21.0	0 - 22 SMU
Antiphosphatidylserine Ab, IgG	18.0	31.0	0 - 15 GPS
Antiphosphatidylserine Ab, IgM	24.0	16.0	0 - 27 MPS