Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis

Case Reports in Rheumatology
Kyoko HonneSeiji Minota

Abstract

A 57-year-old man with rheumatoid arthritis developed severe anemia during treatment with adalimumab plus methotrexate. Cold agglutinin disease was diagnosed because haptoglobin was undetectable, cold agglutinin was positive (1 : 2048), and the direct Coombs test was positive (only to complement). Although the cold agglutinin titer was normalized (1 : 64) after treatment with prednisolone (0.7 mg/kg/day for two weeks), the patient's hemoglobin did not increase above 8 g/dL. When cold agglutinins were reexamined using red blood cells suspended in bovine serum albumin, the titer was still positive at 1 : 1024. Furthermore, the cold agglutinin had a wide thermal amplitude, since the titer was 1 : 16 at 30°C and 1 : 1 at 37°C. This suggested that the cold agglutinin would show pathogenicity even at body temperature. After the dose of prednisolone was increased to 1 mg/kg/day, the patient's hemoglobin rapidly returned to the normal range. The thermal amplitude test using red blood cells suspended in bovine serum albumin is more sensitive than the standard test for detecting pathogenic cold agglutinins.

References

Jun 30, 1977·The New England Journal of Medicine·A D SchreiberM Goldwein
Apr 1, 1977·British Journal of Haematology·G GarrattyJ K Hoops
Jan 1, 1989·Acta Haematologica·M LahavA J Wysenbeek
Aug 1, 1995·Annals of Hematology·R NananH I Huppertz
Aug 1, 1993·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·J D Cherry
Aug 1, 1997·Yonsei Medical Journal·K NairV Geetha
Mar 10, 2004·Internal Medicine·Miki OshimaMasao Kuwabara
Nov 25, 2006·Hematology·Morie A Gertz
Jun 15, 2007·British Journal of Haematology·Morie A Gertz
Oct 2, 2007·Blood Reviews·Lawrence D Petz
Apr 3, 2009·Modern Rheumatology·Hideki NakamuraKatsumi Eguchi
Dec 17, 2009·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Evangelos Cholongitas, Despina Ioannidou
Mar 12, 2010·The American Journal of the Medical Sciences·Nandakumar SrinivasanRoopesh Nahar
Feb 15, 2012·Blood Reviews·Sigbjørn Berentsen, Geir E Tjønnfjord

❮ Previous
Next ❯

Related Concepts

Related Feeds

Autoimmune Hemolytic Anemia

Autoimmune hemolytic anemia (AIHA) occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst (lyse), leading to an insufficient number of oxygen-carrying red blood cells in the circulation. Discover the latest research on AIHA here.

Anemia

Anemia develops when your blood lacks enough healthy red blood cells. Anemia of inflammation (AI, also called anemia of chronic disease) is a common, typically normocytic, normochromic anemia that is caused by an underlying inflammatory disease. Here is the latest research on anemia.