Cold hands point to red cells lysis

An elderly patient is referred for investigation of ‘cold anaemia’, which was first diagnosed 20 years earlier

Bob, 84, was referred for investigation and management of his long-standing anaemia.

Apparently, he had been diagnosed with ‘cold anaemia' almost 20 years previously, which resulted in his moving from Melbourne to Queensland.

Bob recently had a skin cancer surgically removed and repaired with a skin graft.

However, the graft had failed and it was discovered his Hb level had fallen to 65g/L (NR: 110-160g/L).

Examination

On examination, Bob was noted to have mild cognitive impairment. On his forehead there was a 0.7×0.5cm skin deficit exposing

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