A cold agglutinin disease, difficult to distinguish from paroxysmal cold hemoglobinuria
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- YOKOYAMA Tomohisa
- First Department of Internal Medicine, Tokyo Medical University
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- MIYAZAWA Keisuke
- First Department of Internal Medicine, Tokyo Medical University
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- SUNAGA Kazuyo
- Blood Transfusion Division, Tokyo Medical University
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- SUZUKI Shigeru
- Central Clinical Laboratory Division, Tokyo Medical University
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- TANOKURA Chizuru
- Medical Health Center and Clinic of Tokyo-Jistugyou Health Insurance Union
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- HIGAKUBO Tosiaki
- Medical Health Center and Clinic of Tokyo-Jistugyou Health Insurance Union
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- NISIZATO Yosinori
- Medical Health Center and Clinic of Tokyo-Jistugyou Health Insurance Union
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- FUKUTAKE Katsuyuki
- Department of Laboratory Medicine, Tokyo Medical University
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- OHYASHIKI Kazuma
- First Department of Internal Medicine, Tokyo Medical University
Bibliographic Information
- Other Title
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- 発作性寒冷血色素尿症との鑑別が困難であった寒冷凝集素症
- 症例 発作性寒冷血色素尿症との識別が困難であった寒冷凝集素症
- ショウレイ ホッサセイ カンレイ ケッシキソ ニョウショウ ト ノ シキベツ ガ コンナン デ アッタ カンレイ ギョウシュウソショウ
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Abstract
A 58-year-old male started passing dark brown colored urine in January 2002. An annual medical examination in the same month revealed a mild anemia and an increased serum LDH level. Because of the instability of the data of his peripheral red cell count and hemoglobin concentration as measuring with a blood cell auto-analyzer, and also the hemolytic findings in a test tube at room temperature (25°C), he was referred to our hospital. Laboratory data revealed Hb 11.2 g/dl, reticulocytes 73.1‰ (233,000/μl), indirect-bilirubin 2.8 mg/dl, LDH 757 U/l, and hemosiderinuria, suggesting some intravascular hemolysis. The cold agglutinin titer was >1,024, direct and indirect Coombs tests were both positive, and the Donath-Landsteiner antibody (D-L antibody) was initially assessed as false positive because of a high titer of cold agglutinin. He was finally diagnosed as having a cold agglutinin disease (CAD) with anti-I autoantibody. Serologic tests for syphilis and mycoplasma, and various virus tests were all negatives. After avoiding cold exposure, his symptoms, including hemoglobinuria, disappeared. However, during 9 months follow-up, he still showed a high titer of cold agglutinin. This case suggests that CAD should be considered when peripheral blood cell count data are unstable as assessed by a blood cell auto-analyzer.
Journal
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- Rinsho Ketsueki
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Rinsho Ketsueki 44 (6), 375-380, 2003
The Japanese Society of Hematology
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Details 詳細情報について
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- CRID
- 1390282680007732608
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- NII Article ID
- 130004500855
- 10011470206
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- NII Book ID
- AN00252940
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- COI
- 1:STN:280:DC%2BD3szlt12juw%3D%3D
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- ISSN
- 18820824
- 04851439
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- NDL BIB ID
- 6638897
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- PubMed
- 12884815
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- Text Lang
- ja
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- Data Source
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- JaLC
- NDL
- PubMed
- CiNii Articles
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- Abstract License Flag
- Disallowed