LAUSR

An 85- year- old woman who was being treated for an ALK-positive bronchial adenocarcinoma with alectinib, an ALK (anaplastic lymphoma kinase) inhibitor, was hospitalised with a pulmonary embolus. She was found to have a haemoglobin concentration of 135 g/l, a reticulocyte count at 65.4 × 10 9 /l, a conjugated bilirubin of 8.9 µmol/l, unconjugated bilirubin of 15.3 µmol/L and undectectable haptoglobin (<0.10 g/l). Other liver function tests were normal. Her blood film showed ac-anthocytes, spheroacanthocytes and spherocytes (left image, ×100 objective). An eosin- 5- maleimide (EMA) flow cytome-try test showed a 60% decrease in fluorescence intensity com-pared to a control subject (centre and right images), this being even more decreased than in hereditary spherocytosis (HS), which is typically around 20% decreased. The dispersion of the fluorescence peak was greater than in HS and control sub-jects; the peak was broad (CV 30%), whereas it is narrow both in HS and in controls (CV approximately 10%).