14/08/2026
When the Usual Signs Didn't Tell the Whole Story
A previously healthy 6-year-old boy was admitted with fever, breathing difficulties, abdominal pain and recurrent vomiting and was diagnosed with a Rhinovirus-Enterovirus infection.
During his illness, his haemoglobin began to fall rapidly. Despite blood transfusions, the anaemia continued to worsen, leading to his transfer to NMC Royal Hospital Sharjah for further evaluation.
The case was challenging because the usual signs of autoimmune haemolytic anaemia were absent. The Direct Coombs test was repeatedly negative, while his body was producing unusually few young red blood cells, known as reticulocytopenia.
Extensive investigations ruled out inherited blood disorders, nutritional deficiencies, infections, bone marrow disorders and other causes. Bone marrow examination and genetic testing found no evidence of malignancy or hereditary disease.
The clinical picture, however, continued to suggest an unusual form of immune-mediated red blood cell destruction associated with the viral infection.
Treatment included intravenous immunoglobulin, supportive care and blood transfusions when required. At one stage, the child required four transfusions within six days.
Gradually, his condition improved. By the sixth week, his bone marrow began responding, his haemoglobin recovered and the signs of haemolysis settled. He continued to improve, with no recurrence during six months of follow-up.
WHY THIS CASE MATTERS
The combination of haemolysis, a negative Coombs test and unusually low reticulocyte production made this an uncommon and challenging case, requiring detailed investigation, close monitoring and multidisciplinary expertise.
Managed collaboratively by:
Dr. Arwa El Dhuwaib – Specialist, Paediatric Haematology & Oncology
Dr. Deepika Gandhi – Specialist, Paediatrics & Paediatric Intensive Care
Dr. Sherin Ahmed Hefny – Consultant, Clinical Pathology & Haematology
At NMC Royal Hospital Sharjah, complex cases are approached through collaboration, detailed investigation and clinical expertise—because sometimes, finding the answer means looking beyond what is expected.
