Paroxysmal nocturnal hemoglobinuria in a 63-year-old patient

Intermittently occuring hemolytic anemia can be the expression of paroxysmal nocturnal hemoglobinuria (PNH). Diagnosis is made via the detection of decreased resistance of the erythrocytes to acidified serum or osmotic hemolysis. Furthermore, diagnostic proof is provided by the cytometric detection of several erythrocyte populations caused by the altered expression of an anchor protein (PIG-A protein) of the cell membrane. This report is of a case where "black morning urine" has been in existence for more than 10 years and in which the additional occurrence of icterus led to the diagnosis. The patient's spleen had been removed in 1964 because of idiopathic thrombopenia, in retrospect, however, thrombopenia within the framework of PNH should be considered.