Table 1.

Showing relevant investigations during a hospital stay

Complete blood count and peripheral smear	Haemoglobin—59 g/L (normal range 130–160 g/L), white cell counts—15.8×109/L (normal range 45–110×109/L), MCV −86.6fL (normal range 83–100 fL) RDW—17.6% (normal range11%–14%), platelets—10×109/L (normal range 150–410×109/L) The smear shows anisopoikilocytosis, a fair number of microcytes, macrocytes, and polychromophilic cells. Marked thrombocytopenia and 3–4 schistocytes/high power field are also seen (figure 1)
Renal function and urine analysis	Serum urea 37.3 mg/dL (normal range, 10–45 mg/dL), serum creatinine, 0.69 mg/dL (normal range, 0.6–1.5 mg/dL), urine analysis—normal
Liver function test and investigation related to haemolysis	Total bilirubin, 2.12 mg/dL (normal range 0.3–1.4 mg/dL), indirect bilirubin 1.86 mg/dL (normal range 0–0.8 mg/dL), aspartate aminotransferase 137 IU/L, (normal range 0–40 IU/L), alanine transaminase, 118 IU/L (normal range 0–40 IU/L) serum alkaline phosphatase 763 IU/L, (normal range 50–270 IU/L) LDH 1193 U/L, (normal range 240–480 U/L), reticulocyte count 4% (normal range 0.3%–1.5%), negative direct Coombs test
Coagulation profile	PT, APTT and fibrinogen level: normal, D-dimer—3.93 µg/ml (<0.4 µg/mL)
Autoimmune workup	ANA by Hep-2 negative, CRP—227 mg/L (normal range 0–6 mg/L)
Work up for underlying possible infection	Nasopharyngeal and oropharyngeal swab for SARS-CoV-2 virus by RT-PCR: positive. Blood culture and urine culture—negative. Viral serology anti-HBV, anti-HCV and anti-HIV negative. Serum ferritin—2233 ng/mL (normal range18-270 ng/mL), CSF study—normal, IgM and IgG antibody for cytomegalovirus, Epstein-Barr virus and Parvovirus B19—negative, real-time PCR for HSV-1, Anti-Japanese encephalitis virus IgM antibody—negative. Endotracheal tube aspirate culture showed growth of Klebsiella pneumonia.
Bone marrow examination	Bone marrow aspirate smear: particulate and normocellular for age, myeloid: erythroid ratio=7.1:1, histiocytes- increased number and show the presence of haemophagocytosis in form of engulfment of platelets, red cells, normoblasts and occasional polymorphs (figures 2–4)
Radiological investigations	CECT thorax—right-sided moderate to severe hydropneumothorax with enhancing overlying pleura with ICD in situ. Cetrilobular nodular opacities with the tree in bud appearance in the visualised right lung and left lower lobe. Most of them are coalescing to form consolidation patches in the right upper lobe and right middle lobe. Patchy fibrosis is noted in the left upper lobe. Left-sided moderate pleural effusion with the sub-segmental collapse of underlying lung. CT brain normal study, no evidence of bleeding or ischaemia

ANA, Anti nuclear antibody; APTT, Activated partial thromboplastin time; CECT, Contrast enhanced computed tomography; CRP, C reactive protein; CSF, Cerebrospinal fluid; HSV, Herpes simplex virus; ICD, Intercostal drainage; LDH, Lactate dehydrogenase; MCV, Mean corpuscular volume; PT, Prothrombin time; RDW, Red cell distribution width.