A 49-year-old male with pneumonia was treated with high-dose intravenous penicillin. He became jaundiced with yellow sclera. Observe the photograph of his peripheral blood smear.
Since penicillin may in some individuals cause autoimmune hemolytic anemia, the clinician asked for a direct antiglobulin test (DAT). The DAT was positive, indicating that antibodies to the drug were produced, which then attached to the drug on the surface of the red cells. Hemolysis followed, leaving the patient with jaundice and a peripheral blood smear that include spherocytes, polychromatophilic cells and sometimes nucleated red blood cells, as seen in this case.
