Abstract | OBJECTIVES: DESIGN: Descriptive case report. SETTING: A pediatric intensive care unit in a university children's hospital. PATIENT: INTERVENTION: MEASUREMENTS AND MAIN RESULTS: The patient presented to an emergency department with an initial hematocrit of 22%, which fell to 12% by hospital admission. She received nine transfusions over 7 days, with her hematocrit reaching a nadir of 11% on the 5th day of hospitalization. Once plasmapheresis was initiated, she required no further transfusion. Analysis of serum from initial presentation demonstrated biphasic hemolysis, confirming the presence of the DL antibody. CONCLUSIONS: In AIHA, in which the direct antiglobulin test detects primarily C3 rather than immunoglobulin G, especially in children, the DL antibody must be considered. Confirming the diagnosis rapidly may be critical, especially in cases of severe hemolysis, because this may help direct therapy. A low titer of DL antibody can mediate severe intravascular hemolysis given its propensity to sensitize, detach, and rebind erythrocytes with changes in temperature in the microcirculation. However, given the transient and relatively brief production of the DL antibody in postviral illness, early clearance of the offending antibody may be possible with plasmapheresis, without the expectation for significant rebound antibody production, potentially decreasing the length of hospital stay and the need for transfusions.
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Authors | Arup Roy-Burman, Bertil E Glader |
Journal | Critical care medicine
(Crit Care Med)
Vol. 30
Issue 4
Pg. 931-4
(Apr 2002)
ISSN: 0090-3493 [Print] United States |
PMID | 11940774
(Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Autoantibodies
- Donath-Landsteiner antibody
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Topics |
- Anemia, Hemolytic, Autoimmune
(diagnosis, therapy)
- Autoantibodies
(blood)
- Blood Transfusion
- Child, Preschool
- Female
- Humans
- Plasmapheresis
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