ABSTRACT
The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.
ABSTRACT
Resumen Infection by SARS-CoV-2 virus is not solely limited to the common clinical presentation of acute respiratory distress syndrome, mainly because a wide spectrum of clinical manifestation has been observed. These presentations include, but are not limited to, neurological, cardiovascular, throm- boembolic, hematologic, and autoimmune presentations. Within this wide spectrum, cases of autoimmune hemolytic anemia due to SARS-CoV-2 infection are rising. This is why primary care physicians should be ready to identify this clinical entity appropriately.
Abstract Infection by SARS-CoV-2 virus is not solely limited to the common clinical presentation of acute respiratory distress syndrome, mainly because a wide spectrum of clinical manifestation has been observed. These presentations include, but are not limited to, neurological, cardiovascular, throm- boembolic, hematologic, and autoimmune presentations. Within this wide spectrum, cases of autoimmune hemolytic anemia due to SARS-CoV-2 infection are rising. This is why primary care physicians should be ready to identify this clinical entity appropriately.
ABSTRACT
ABSTRACT Objectives The purpose of this study was to compare data obtained from the reticulocyte channel (RET channel) heated to 41 °C with those obtained from impedance channel (I-Channel) at room temperature in the samples with the mean corpuscular hemoglobin concentration (MCHC) < 370 g/L and in samples with the MCHC > 370 g/L, in the presence of cold agglutinins. Methods In this study, 60 blood samples (group 1) with the MCHC < 370 g/L (without cold agglutinins) and 78 blood samples (group 2) with the MCHC > 370 g/L (with cold agglutinins) were used to compare the two analytical channels of the XN-9000 analyzer in different preanalytical conditions. The parameters evaluated in both groups were the following: red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean cell volume (MCV), RBC-most frequent volume (R-MFV), mean hemoglobin concentration (MCH) and mean cellular hemoglobin concentration (MCHC). Results The results of this study showed an excellent correlation with both channels of the XN-9000 analyzer in samples with and without cold agglutinins, except for the MCHC. The bias between the values obtained in the I-channel and those obtained in the RET channel of both groups was insignificant and remained within the limits of acceptability, as reported by Ricos et al. for all considered parameters, except for MCHC. Conclusions The presence of cold agglutinins in blood samples can be detected by a spurious lowering of the RBC count and by a spurious increase in the MCHC. The RET channel represents a great opportunity to correct the RBC count in a rapid manner without preheating. However, neither methodology can completely solve the residual presence of cold agglutinins in all samples, despite the MCHC values being < 370 g/L.
Subject(s)
Reticulocytes , Agglutinins , Anemia, Hemolytic, AutoimmuneABSTRACT
Objective To explore the feasibility of preheating in 41 ℃ water bath for 30 minutes to correct the red blood cell parameters in the specimens containing high-titer cold agglutinins(CAs). Methods Two specimens containing high-titer CAs were selected during work,and the parameters of complete blood count at room temperature or after preheating in 37 ℃ or 41 ℃ water bath were compared.The smears were stained,and the distribution of red blood cells was observed with a microscope.Further,74 specimens without CAs were collected for complete blood count,and then the test results at room temperature and after preheating at 41 ℃ were compared. Results At room temperature,the specimens containing high-titer CAs showed significantly reduced red blood cell count(RBC)and hematocrit(HCT),abnormally increased mean corpuscular hemoglobin(MCH)and mean cell hemoglobin concentration(MCHC),abnormal percents of hemoglobin(HGB)and RBC,and aggregation of a large number of red blood cells.After being preheated at 37 ℃ for a certain time,the specimens demonstrated obviously improved parameters while still aggregation of a small number of red blood cells.After being preheated at 41 ℃ for 30 minutes,the specimens showed significantly increased RBC,normal HCT,MCH,and MCHC,and evenly distributed red blood cells.The 74 specimens without CAs showed the comparability was ≥80% between room temperature and preheating at 41 ℃ for 30 minutes or 60 minutes. Conclusion We can preheat the specimens containing high-titer CAs in a water bath at 41 ℃ to obtain accurate red blood cell parameters.
Subject(s)
Cryoglobulins , Erythrocyte Count , Erythrocytes , Feasibility Studies , HematocritABSTRACT
El síndrome de Evans es un trastorno poco frecuente en el que se observan trombocitopenia y anemia, ambas de etiología autoinmune; las que pueden ocurrir de manera simultánea o sucesiva. Se presenta un caso poco usual de anemia hemolítica autoinmune por anticuerpos fríos asociada a púrpura trombocitopénica autoinmune. Paciente femenina de 22 años de edad con diagnóstico de púrpura trombocitopénica autoinmune, después de 7 años de evolución y un año en remisión, presentó una anemia hemolítica autoinmune por anticuerpos fríos, refractaria al tratamiento con esteroides y alcaloides de la Vinca, que requirió transfusiones de concentrado de eritrocitos y logró la remisión con la administración de anticuerpo monoclonal anti CD 20. Los restantes estudios de autoinmunidad fueron negativos. Actualmente se mantiene asintomática y sin tratamiento inmunosupresor(AU)
Evans syndrome is a rare disorder in which thrombocytopenia and anemia are observed, both of autoimmune aetiology, which may occur simultaneously or successively. A rare case of cold autoimmune hemolytic anemia associated to autoimmune thrombocytopenic purpura is presented. A 22-year-old female patient with diagnosis of autoimmune thrombocytopenic purpura, after 7 years of evolution and one year in remission, has a cold autoimmune hemolytic anemia, refractory to steroid treatment and vinca alkaloids, which requires transfusions of packed erythrocytes and achieves remission with anti CD 20 monoclonal antibody. The remaining studies of autoimmunity are negative. Currently the patient is asymptomatic and without immunosuppressive therapy(AU)
Subject(s)
Humans , Female , Adult , Anemia, Hemolytic, Autoimmune/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Thrombocytopenia/complications , Agglutinins , Rituximab/therapeutic useABSTRACT
Cold agglutinins are predominately immunoglobulin M autoantibodies that react at cold temperatures with surface antigens on the red blood cell. This can lead to hemagglutination at low temperatures, followed by complement fixation and subsequent hemolysis on rewarming. Development of hemagglutination or hemolysis in patients with cold agglutinins is a risk of cardiac surgery under hypothermia. In addition, there is the potential for intracoronary hemagglutination with inadequate distribution of cardioplegic solutions, thrombosis, embolism, ischemia, or infarction. We report a patient with incidentally detected cold agglutinin who underwent normothermic cardiac surgery with warm blood cardioplegia.
Subject(s)
Humans , Agglutinins , Antigens, Surface , Autoantibodies , Cardioplegic Solutions , Cardiopulmonary Bypass , Cold Temperature , Complement System Proteins , Embolism , Erythrocytes , Heart Arrest, Induced , Hemagglutination , Hemolysis , Hypothermia , Immunoglobulin M , Infarction , Ischemia , Rewarming , Thoracic Surgery , ThrombosisABSTRACT
Paciente mujer de 36 años de edad, quien consulta por síntomas respiratorios de dos semanas de evolución, con diagnóstico de ingreso de neumonía adquirida en la comunidad. evolución clínica complicada con anemia hemolítica por hemaglutininas frías que hace sospechar infección neumónica por Mycoplasma pneumoniae, confrmada mediante serología. Tras curso corto de prednisona oral, ácido fólico y antibioticoterapia, se presenta resolución de la anemia y mejoría clínica de la neumonía. este informe de caso resalta la elevada amplitud térmica de las aglutininas frías como condición para generar hemólisis inmune y la ausencia de reticulocitosis compensatoria de la hemólisis, complicaciones inusuales en neumonía por Mycoplasma pneumoniae, pero determinantes de la severidad de la anemia. además, enfatiza la utilidad de los títulos de aglutininas frías en el diagnóstico de neumonía adquirida en la comunidad debida a Mycoplasma pneumoniae.
We present the case of a 36 years old female patient, who consults for respiratory symptoms during two weeks, with admission diagnosis of community-acquired pneumonia. the clinical course was complicated by hemolytic anemia by cold hemagglutinin that suggests pneumonic infection by Mycoplasma pneumoniae, confrmed by serology. After short course of oral prednisone, folic acid and antibiotic therapy, resolution of anemia and clinical improvement of the pneumonia were obtained. this case report highlights the high temperature range of cold agglutinins as a condition for generating immune hemolysis and the absence of compensatory reticulocytosis of hemolysis, which are rare pneumonia complications of Mycoplasma pneumoniae, but that are determinants of the severity of the anemia. it also emphasizes the usefulness of cold agglutinin titers in the diagnosis of community-acquired pneumonia due to Mycoplasma pneumoniae.