A 50 year old male is seen in his physician’s office for aroutine checkup. His spleen shows enlargement and his blood workshows hemolytic anemia with bilirubinemia. His wife states thepatient has been “off†lately for no apparent reason. He tends tohave muscle pulsations in the afternoon to late evening that do notstop until he goes to sleep. Additional blood work is ordered alongwith a type and screen. His haptoglobin levels are decreased, andhis physician orders two units of packed RBCs. His antibody screenresults show he has a weakened expression of Kell antigens.
What is the most likely diagnosis?
