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Báo cáo y học: "Fatal cold agglutinin-induced haemolytic anaemia: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Fatal cold agglutinin-induced haemolytic anaemia: a case report. | Lodi et al. Journal of Medical Case Reports 2010 4 252 http www.jmedicalcasereports.eom content 4 1 252 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Fatal cold agglutinin-induced haemolytic anaemia a case report Gianluca Lodi Daniela Resca Roberto Reverberi Abstract Introduction Cold agglutinin disease usually develops as a result of the production of a specific immunoglobulin M auto-antibody directed against the I i and H antigens precursors of the ABH and Lewis blood group substances on red blood cells. Autoimmune and lymphoproliferative disorders Mycoplasma pneumoniae and other infections can be associated with the production of cold agglutinins. In its classic presentation with haemolytic anaemia and Raynaud s syndrome cold agglutinin disease is usually idiopathic. Several factors play a role in determining the ability of a cold agglutinin to induce a haemolytic anaemia such as antibody concentration and temperature range in particular the highest temperature at which antibodies interact with red blood cells. Case presentation A 48-year-old Caucasian man presented to our hospital with symptoms of extreme asthenia caused by severe anaemia. The transfusion of red blood cells O Rh-positive started as prescribed by the emergency guidelines in force without pre-transfusion tests induced fatal haemolysis because of the presence of high levels of anti-H antibodies in his blood that reacted with the large amount of H antigen in universal 0 red blood cells. Conclusion Emergency transfusion of universal red blood cells 0 Rh-positive or negative is usually accepted by the international guidelines in force in emergency departments. In this report we describe a rare complication caused by the very high concentration in the recipient of cold agglutinins and the activation of the complement system responsible for red blood cell lysis and consequent fatal cardiovascular shock. We conclude that emergency transfusion of universal red blood cells 0 Rh-positive .