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Jaundice and anaemia
  1. T Makishi,
  2. A Hokama,
  3. H Sakugawa,
  4. T Nakayoshi,
  5. T Maeshiro,
  6. K Maeda,
  7. J Shiroma,
  8. T Oshiro,
  9. F Kinjo,
  10. A Saito
  1. First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
  1. Correspondence to:
    Dr A Hokama
    First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan;

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Clinical presentation

A 50 year old woman presented with progressive jaundice and shortness of breath. She had no history of blood transfusions or recent travel. She had been taking more than 120 g of alcohol per day for 20 years. Her family history was unremarkable. On examination, jaundice, oedema, splenomegaly, and flapping tremor were notable. Laboratory values were as follows: leucocytes 3.8×109/l; haemoglobin 5.6 g/dl; platelet count 33×109/l; alanine aminotransferase 49 IU/l; aspartate aminotransferase 16 IU/l; lactate dehydrogenase 439 IU/l; total bilirubin 15.7 mg/dl; indirect bilirubin 11.4 mg/dl; albumin 2.9 g/dl; cholesterol 205 mg/dl; ferritin 968 μg/l; and prothrombin activity 28%. Tests for hepatitis B surface antigen, anti-hepatitis C virus antibody, antinuclear antibody, and antimitochondrial antibody were negative.


A peripheral blood smear (fig 1) and an abdominal T2 weighed magnetic resonance image (fig 2) are depicted. What is the diagnosis?

Figure 1

 Peripheral blood smear.

Figure 2

 Abdominal T2 weighed magnetic resonance image.

See page 1308 for answer

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  • Robin Spiller, Editor

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