Hot and Cold
A 5-year-old boy presents to the emergency department (ED) with 2 days of fever (temperature 100.7 °F), fatigue, jaundice, and dark urine. The parents note that the child had symptoms of a viral upper respiratory illness 2 weeks before presentation and that he was previously healthy with no history of blood transfusion. In the ED, the child weighs 21.3 kg, and laboratory workup reveals severe anemia with hemoglobin (Hgb) 5.4 g/dL, elevated total bilirubin 5.1 mg/dL, aspartate aminotransferase (AST) 357 U/L (normal range, 8–60 U/L), and lactate dehydrogenase (LDH) 8126 U/L. Serum haptoglobin is undetectable. Urinalysis results are as follows: color, dark; red blood cells (RBCs), 0–3 per high-power field; and urine Hgb, 3+ positive. Notably, the onset of symptoms (fever, fatigue, jaundice, dark urine) was associated with eating a bowl of ice cream. An ethylenediaminetetraacetic acid (EDTA) anticoagulant type and screen sample is submitted to the blood bank along with a request for RBC transfusion.
KeywordsAutoimmune hemolytic anemia Biphasic hemolysin Donath-Landsteiner P antigen Paroxysmal cold hemoglobinuria/PCH
- 1.Salido EJ, Cabañas V, Berenguer M, Macizo MI, García-Candel F, Pérez-López R, Moraleda JM. Serological findings in a child with paroxysmal cold haemoglobinuria. Case Rep Med. 2014;2014:Article ID 316010. https://www.hindawi.com/journals/crim/2014/316010/ Accessed 3 Mar 2018.
- 2.Vaglio S, Arista MC, Perrone MP, Tomei G, Testi AM, Coluzzi S, Girelli G. Autoimmune hemolytic anemia in childhood: serologic features in 100 cases. Transfusion 2007;47(1):50–54.Google Scholar
- 4.Leger RM. The positive direct antiglobulin test and immune-mediated hemolysis. In: Fung MK, Grossman BJ, Hillyer CD, Westhoff CM, editors. Technical manual. 18th ed. Bethesda: AABB; 2014. p. 440.Google Scholar