A 25yr old female presents with anemia and jaundice since 2 years. On examination her spleen is enlarged. Peripheral smear showed presence of spherocytes. Which of the following investigation is used in diagnosing this condition?
**Core Concept:** Spherocytes are spherical red blood cells with abnormal morphology, often seen in conditions causing hemolysis or hemoglobinopathy. Hepatobiliary system involvement in these conditions can present with jaundice and splenomegaly.
**Why the Correct Answer is Right:** A correct diagnosis for spherocytes and associated jaundice and splenomegaly requires an investigation that can identify the underlying cause. In this case, the correct answer is:
**Correct Answer: C.** Serum Bilirubin levels, SGOT (AST), SGPT (ALT), and alkaline phosphatase (ALP) levels should be done to assess liver function, as these enzymes are elevated in hemolysis and liver diseases. Elevated levels of these enzymes indicate liver dysfunction, which may be seen in hemolysis and hemoglobinopathies.
**Why Each Wrong Option is Incorrect:**
A. Haemoglobin electrophoresis: While this test helps differentiate between different types of hemoglobinopathies, it is not specific for hemolysis and liver dysfunction.
B. Liver function tests: Although liver function tests are important in assessing liver function and may indicate hemolysis or hemoglobinopathy, they are not specific for hemolysis and liver dysfunction.
D. Serum ceruloplasmin and alpha 1 antitrypsin levels: These tests are involved in copper and alpha-1 antitrypsin deficiency, respectively, and are not relevant to hemolysis and liver dysfunction caused by spherocytes.
**Clinical Pearl:** In cases of spherocytes and associated jaundice and splenomegaly, a comprehensive panel of liver function tests, along with hemoglobin electrophoresis, is essential to arrive at the correct diagnosis. A high index of suspicion is necessary when encountering atypical clinical presentations, as in this case.