A case of Coombs negative hemolytic anemia with hypoalbuminemia, hypocholesterolemia, and mildly elevated bilirubin suggests what diagnosis?

In the context of a case demonstrating Coombs negative hemolytic anemia alongside hypoalbuminemia, hypocholesterolemia, and mildly elevated bilirubin, the diagnosis of histiocytic neoplasia is particularly relevant. Histiocytic neoplasia encompasses conditions such as histiocytic sarcoma, which is associated with a systemic inflammatory response and increased destruction of red blood cells.

The combination of low albumin and cholesterol levels suggests a significant disruption in protein synthesis or consumption, frequently seen in neoplastic conditions. In cases of histiocytic neoplasia, the infiltrative nature of the neoplastic cells can lead to organ dysfunction and a consumptive coagulopathy, contributing to the observed lab findings. Additionally, the mild elevation in bilirubin aligns with hemolysis or liver dysfunction, both of which can occur in the context of tumors affecting hemolysis and hepatic function.

While autoimmune hemolytic anemia is associated with a positive Coombs test, the absence of this finding in this scenario steers the diagnosis away from autoimmune conditions. Chronic kidney disease may present with multiple hematological changes but typically would involve more complex profiles, and lymphoma, although it can be related to anemia, usually presents with additional characteristic signs or lab findings