Development of mixed-type autoimmune hemolytic anemia and Evans' syndrome following chicken pox infection in a case of low-titer cold agglutinin disease.

We describe a patient with low-titer cold agglutinin disease (CAD) who developed mixed-type autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenia following chicken pox infection. At least 1 year before admission to hospital, the patient had mild hemolytic anemia associated with low-titer cold agglutinins. A severe hemolytic crisis and thrombocytopenia (Evans' syndrome) occurred several days after infection with chicken pox, and the patient was referred to our hospital. Serological findings revealed the presence of both cold agglutinins and warm-reactive autoantibodies against erythrocytes, and the diagnosis was mixed-type AIHA. Following steroid therapy, the hemoglobin (Hb) level and platelet count improved. The patient was closely followed over a 10-year period with recurrent documented hemolysis after viral or bacterial infections. Warm-reactive autoantibodies have not been detected in the last 2 years, and only the immunoglobulin M anti-I cold agglutinins with a low titer and wide thermal amplitude have remained unchanged. Therefore, the patient has received at least 10 mg prednisolone daily to maintain a Hb level of 10 g/dL. To the best of our knowledge, no adult case of low-titer CAD that has evolved into mixed-type AIHA and Evans' syndrome after chicken pox infection has been previously reported in the literature.
AuthorsYumi Tanaka, Masahiro Masuya, Naoyuki Katayama, Eri Miyata, Yuka Sugimoto, Tetsunori Shibasaki, Kentaro Yamamura, Kohshi Ohishi, Nobuyuki Minami, Hiroshi Shiku, Tsutomu Nobori
JournalInternational journal of hematology (Int J Hematol) Vol. 84 Issue 3 Pg. 220-3 (Oct 2006) ISSN: 0925-5710 [Print] United States
PMID17050195 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Anti-Inflammatory Agents
  • Autoantibodies
  • Hemoglobins
  • Immunoglobulin M
  • Prednisolone
  • Anemia, Hemolytic, Autoimmune (blood, complications, drug therapy, etiology)
  • Anti-Inflammatory Agents (administration & dosage)
  • Autoantibodies (blood)
  • Chickenpox (blood, etiology)
  • Female
  • Follow-Up Studies
  • Hemoglobins (analysis)
  • Humans
  • Immunoglobulin M (blood)
  • Middle Aged
  • Platelet Count
  • Prednisolone (administration & dosage)
  • Syndrome
  • Thrombocythemia, Essential (blood, drug therapy, etiology)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!

Choose Username:
Verify Password: