Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Paroxysmal cold hemoglobinuria in an elderly patient: A rare case with poor prognosis
Poras Patel1, Elizebath Guevara2, Avani Changela2, Yu Yu Thar2
1Department of Medicine, The Brooklyn Hospital Center, USA.
2Division of Hematology/Oncology, The Brooklyn Hospital Center, USA.

Article ID: 100013Z09PP2016
doi:10.5348/Z09-2016-13-CR-6

Address correspondence to:
Poras Patel
MD, Department of Medicine, the Brooklyn Hospital Center
121 Dekalb Avenue, Brooklyn
NY 11201
USA

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How to cite this article:
Patel P, Guevara E, Changela A, Thar YY. Paroxysmal cold hemoglobinuria in an elderly patient: A rare case with poor prognosis. J Case Rep Images Med 2016;2:20–23.


Abstract
Introduction: Paroxysmal cold hemoglobinuria (PCH) is a very rare type of cold-mediated autoimmune hemolytic anemia causing direct intravascular hemolysis and hemoglobinuria, typically after exposure to cold. The reaction is caused by an IgG antibody known as Donath-Landsteiner (D-L), which binds specifically to the P antigen of red blood cells at low temperatures, leading to complement activation and red cell lysis.
Case Report: We report a case of rare occurrence of acute syphilitic paroxysmal cold hemoglobinuria in an elderly female with evidence of intravascular hemolysis complicated with peripheral gangrene and multiple organ dysfunctions.
Conclusion: The prognosis of PCH associated with syphilis is usually considered excellent and benign. However, we encountered a syphilitic PCH in an elderly female with a grave prognosis who passed away within five months after her first episode. Based on our case experience, we recommend that acute episodes of PCH in an elderly patient should be treated in a closely monitored setting with high dose of steroids and warm blankets.

Keywords: Anemia, Donath-Landsteiner (D-L), Hemolytic anemia, Hemoglobinuria, Paroxysmal cold hemoglobinuria (PCH)


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Author Contributions
Poras Patel – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Elizebath Guevara – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Avani Changela – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yu Yu Thar – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Poras Patel et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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