Paroxysmal nocturnal haemoglobinuria: an easily missed entity

A 27‐year‐old man presented to the emergency department of our hospital in June 2016 with right upper quadrant abdominal pain which had gradually worsened in the previous week. He reported fatigue, exertional dyspnoea and intermittent abdominal pain in the past 2 years, which impaired his work and quality of life. He also provided a history of passing dark‐coloured urine in the mornings intermittently during this period, and for all these symptoms, he made a few visits to his general practitioner. As the abdominal computed tomography scans were non‐diagnostic at that time, he was treated as having recurrent abdominal infections with antibiotics. It was also noted that his haemoglobin and ferritin levels were low, for which he was started on iron supplements. After some improvement, his symptoms recurred after a few months. He had no significant family history.