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Jacobs JW, Booth GS, Woo JS, Stephens LD, Figueroa Villalba CA, Adkins BD. Challenges in recognising paroxysmal cold hemoglobinuria. Transfus Med 2024; 34:71-73. [PMID: 38151804 DOI: 10.1111/tme.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | | | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Zieg J, Flachsová E, Linhartová E, Konopásek P, Štolbová Š, Šimánková N, Fencl F, Pavlíček P, Suková M. Severe Acute Kidney Injury in Children as a Rare Complication of Paroxysmal Cold Hemoglobinuria. J Pediatr Hematol Oncol 2023; 45:e1010-e1013. [PMID: 37703450 DOI: 10.1097/mph.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
Paroxysmal cold hemoglobinuria (PCH) is a rare condition in childhood characterized by complement-mediated premature destruction of red blood cells. PCH is associated with intravascular hemolysis causing hemoglobinuria, which may result in acute kidney injury of various severity. We aimed to retrospectively analyze clinical and laboratory features of children with PCH-associated acute kidney injury received at tertiary Pediatric Hematology and Nephrology Center, University Motol Hospital, Prague, Czech Republic during the period 2016 to 2022. We present here 3 children with PCH-associated acute kidney failure requiring renal replacement therapy. We highlight the association of PCH with kidney disease. Renal parameters and urine examination should be regularly tested in all children with PCH.
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Affiliation(s)
| | | | - Eva Linhartová
- Department of blood bank, Motol University Hospital, Prague, Czech Republic
| | | | | | | | | | | | - Martina Suková
- Pediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol
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3
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Villar-Prados A, Abdelmonem M, Duda M, Chien M, Yunce M. A single center experience for clinical evaluation of paroxysmal cold hemoglobinuria and Donath-Landsteiner testing. Transfusion 2023; 63:1969-1977. [PMID: 37632701 DOI: 10.1111/trf.17520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Paroxysmal cold hemoglobinuria (PCH) is a rare form of autoimmune hemolytic anemia (AIHA), mainly affecting children. The diagnosis and management are challenging due to similarities to other causes for AIHA and limited availability to Donath-Landsteiner (DL) testing. STUDY DESIGN AND METHODS In this single-center retrospective study, we aimed to characterize the clinical presentation and outcomes of PCH patients, defined as having positive Donath-Landsteiner antibodies, compared to a cohort of AIHA patients. RESULTS DL-positive patients were observed to have higher lactate dehydrogenase levels and lower reticulocyte counts compared to DL-negative patients, although this was not statistically significant. We also observed that using steroids in DL-positive patients did not significantly impact their recovery. DISCUSSION Our findings support the limited published data on PCH patients and further prompt larger multicenter studies to further characterize these patients so that they are more readily identified, especially in centers where DL antibody testing is not readily available.
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Affiliation(s)
- Alejandro Villar-Prados
- Department of Medicine. Division of Hematology and Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Molly Duda
- Department of Medicine. Division of Hematology and Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - May Chien
- Department of Medicine. Division of Hematology and Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Muharrem Yunce
- Clinical Laboratory, Stanford Healthcare, Palo Alto, California, USA
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
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Williams JD, Jayaprakash RK, Kithany H, Tighe MP. How to use Donath-Landsteiner test to diagnose paroxysmal cold haemoglobinuria (PCH). Arch Dis Child Educ Pract Ed 2022; 107:199-206. [PMID: 34433582 PMCID: PMC9125376 DOI: 10.1136/archdischild-2020-319568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
Paroxysmal cold haemoglobinuria (PCH) accounts for around a third of cases of autoimmune haemolytic anaemia in children. PCH is caused by an autoantibody that fixes complement to red cells at low temperatures and dissociates at warmer temperatures (a biphasic haemolysin), triggering complement-mediated intravascular haemolysis. Named the Donath-Landsteiner (D-L) antibody after its discoverers, it is usually formed in response to infection and demonstrates specificity for the ubiquitous red cell P-antigen. A D-L test can be used to detect the presence of the D-L autoantibody in the patients' serum. Here we discuss the use of the D-L test in identifying PCH in a 2-year-old boy who presented with haemolytic anaemia. A summary of the key information can be found in the infographic.
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Affiliation(s)
| | - Ram K Jayaprakash
- Haematology, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
| | - Heena Kithany
- Paediatrics, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
| | - Mark Peter Tighe
- Paediatrics, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
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Paroxysmal cold hemoglobinuria in a 7-year-old male child – Was it really cold induced? A diagnostic and management dilemma. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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6
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Paroxysmal cold hemoglobinuria successfully treated with complement inhibition. Blood Adv 2020; 3:3575-3578. [PMID: 31738828 DOI: 10.1182/bloodadvances.2019000897] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022] Open
Abstract
Key Points
This is the first-ever demonstration of successful treatment of paroxysmal cold hemoglobinuria using the complement inhibitor eculizumab.
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Radonjić Z, Andrić B, Šerbić O, Mićić D, Kuzmanović M, Jovanović-Srzentić S, Dinić R. A rare case report of autoimmune haemolytic anemia in a female child due to a Donath-Landsteiner antibody. Transfus Clin Biol 2020; 27:83-86. [PMID: 32249165 DOI: 10.1016/j.tracli.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
Paroxysmal cold hemoglobinuria is a rare form of autoimmune hemolytic anemia caused by the Donath-Landsteiner autoantibody. The condition is characterized by the presence of an IgG biphasic hemolysin with specificity to the P blood group antigen. The antibody biphasic action may be demonstrated in the Donath-Landsteiner test. While paroxysmal cold hemoglobinuria can be manifested at any age, it typically appears in children following a viral upper respiratory syndrome or immunization, though rarely. This report describes a 23-months old girl presented with 5 days history of fever, erythrocytopenia, leukocytosis and occurrence of dark urine. On admission, the physical examination showed pallor, no scleral icterus, a mild hyperemic throat and no hepatosplenomegaly. The investigations revealed severe anemia with hemoglobin of 44g/L, increased reticulocyte count (10.67%), elevated lactate dehydrogenase (2603IU/L), decreased serum haptoglobin (0.159g/L), normal G6PD. Direct antiglobulin test was positive with C3d and C3c complement components only. Direct and indirect Donath-Landsteiner tests were positive. The girl was treated with a intravenous immunoglobulin infusion and Cefotaxime. She received transfusion of red blood cells, crossmatched, although P antigen untyped. Despite this in vitro serological incompatibility she had a hemoglobin increase. The patient was discharged in stable condition on the seventh day following admission. Paroxysmal cold hemoglobinuria is a hemolytic anemia for which a specific diagnostic test is available. Timely recognition of the disease by pediatricians is crucial as well as the highly skilled hospital blood bank staff performing Donath-Landsteiner testing.
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Affiliation(s)
- Z Radonjić
- Department of Blood Transfusion, Institute for Mother and Child Health Care "Dr Vukan Čupić", Radoja Dakića 6-8, 11070 New Belgrade, Serbia.
| | - B Andrić
- Department of Blood Transfusion, Institute for Mother and Child Health Care "Dr Vukan Čupić", Radoja Dakića 6-8, 11070 New Belgrade, Serbia.
| | - O Šerbić
- Department of Blood Transfusion, Institute for Mother and Child Health Care "Dr Vukan Čupić", Radoja Dakića 6-8, 11070 New Belgrade, Serbia.
| | - D Mićić
- Department of Hematooncology, Institute for Mother and Child Health Care "Dr Vukan Čupić", Radoja Dakića 6-8, 11070 New Belgrade, Serbia.
| | - M Kuzmanović
- Department of Hematooncology, Institute for Mother and Child Health Care "Dr Vukan Čupić", Radoja Dakića 6-8, 11070 New Belgrade, Serbia; Faculty of Medicine Belgrade, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia.
| | - S Jovanović-Srzentić
- Department for prenatal testing and molecular typing of blood groups, Institute for Blood Transfusion of Serbia, Svetog Save 39, 11000 Belgrade, Serbia.
| | - R Dinić
- Department of pretransfusion testing and hemovigilance, Institute for Blood Transfusion of Serbia, Svetog Save 39, 11000 Belgrade, Serbia.
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Menchetti I, Lin Y, Cserti-Gazdewich C, Goldstein J, Law C, Lazarus A, Callum JL. Complications of a severe autoimmune hemolytic anemia crisis: transfusional iron overload and gangrenous cholecystitis. Transfusion 2018; 58:2777-2781. [PMID: 30291762 DOI: 10.1111/trf.14888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies. CASE REPORT A 66-year-old male patient with a 17-year history of Evans syndrome presented with fulminant autoimmune hemolytic anemia (AIHA). He presented with a markedly elevated C-reactive protein (CRP; 46 mg/L [normal, 0-5 mg/L]) before onset of a decrease in hemoglobin. He required the transfusion of 20 units of red blood cells while awaiting response to aggressive immunosuppressive therapy including high-dose corticosteroids, intravenous immunoglobin therapy, and rituximab. He achieved a complete hematologic response. RESULTS His postdischarge course was complicated by acute cholecystitis requiring laparoscopic cholecystectomy. In addition, his transfusional iron overload requiring 16 phlebotomies to reduce his ferritin level from 4933 μg/L to 326 μg/L, with phlebotomies ongoing every 2 weeks to achieve a ferritin level of less than 100 μg/L. CONCLUSION Neither transfusional iron overload nor acute cholecystitis are well-recognized complications of a severe episode of AIHA. An elevated CRP has been recently recognized as an important prognostic marker in patients with immune thrombocytopenic purpura and this case suggests a need to evaluate its utility in AIHA.
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Affiliation(s)
| | - Yulia Lin
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Calvin Law
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alan Lazarus
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeannie L Callum
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Cooling LL. Kids, colds, and complement: paroxysmal cold hemoglobinuria. Transfusion 2017; 57:1332-1335. [DOI: 10.1111/trf.14128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
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