PNH in Focus: Neepaja Canjiradan Discusses Hemolysis, Diagnostic Clues, and Complement Inhibitor Therapy
Neepaja Canjiradan, a clinical pathologist at AVM Labs, posted on LinkedIn:
”Haematology series 17
Paroxysmal nocturnal Haemoglobinuria: The only condition where your urine says “Good Morning” darker than your coffee
On the Peripheral Smear
Hemolysis galore → bite cells, ghost cells, and the occasional schistocyte cameo.
Reticulocytosis – marrow working overtime like a resident on night duty.
Basically looks like “aftermath of a complement bar fight.”
In the Bone Marrow
Hypoplastic/aplastic in some, hyperplastic in others.
Erythroid hyperplasia = marrow screaming “I got this!” while clearly not.
Frequently hand-in-hand with aplastic anemia or MDS-PNH is never lonely.
Flow Cytometry (the Real MVP)
The mic-drop moment → loss of CD55 and CD59 on RBCs and granulocytes.
Forget the Ham test—flow cytometry is the Sherlock Holmes here.
Seeing that PNH clone pop up is equal parts diagnostic thrill and clinical reality check.
Treatment in a Nutshell
Big strides from IV infusions to oral therapies.
Complement inhibitors galore, but let the hematologists juggle the alphabet soup.
HSCT = still the only curative pathway.
Pathologist’s Humor Corner
PNH patients: “Why is my urine so dark in the morning?”
Pathologist: “Because your RBCs had a rough night.”
RBCs without CD55/CD59 → the ultimate example of what happens when you skip PPE.
Flow cytometry in PNH = Facebook relationship status: “It’s complicated.”
Bottom Line
Smear gives the clues,
Marrow shows the struggle,
Flow cytometry seals the deal.
PNH may be rare, but it keeps pathology exciting – diagnostics with just the right mix of science and sass.”
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