Which combination of symptoms is classic for Paroxysmal Nocturnal Hemoglobinuria?

• A. Unexplained hemolytic anemia with fatigue, jaundice, dark urine
• B. Chronic cough and wheeze
• C. Hyperglycemia
• D. Anorexia

Answer: (A)

In Paroxysmal nocturnal hemoglobinuria, the problem is intravascular hemolysis caused by a deficiency of protective GPI-anchored proteins on red blood cells, which makes them highly susceptible to complement-mediated destruction. This leads to a pattern of hemolysis that shows up as anemia with symptoms like fatigue, as well as signs from the breakdown of hemoglobin. The released heme increases bilirubin, producing jaundice, and free hemoglobin in the blood is filtered by the kidneys, giving urine a dark, reddish-brown color, especially noticeable in the first morning urine when hemolysis is often more evident. This combination—unexplained hemolytic anemia with fatigue, jaundice, and dark urine—fits the classic presentation of PNH. The other options describe symptoms that do not align with this hemolysis-driven process.