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COLLEGE OF ALLIED MEDICAL PROFESSIONS
Hematology LABORATORY
Case analysis
Paroxysmal
Cold
hemoglobinuri
a
Submitted by:
Group 9
BS MT 3-C
Group Leader: David, Kyla Denise
Members: De Jesus, Kim Paula
Leongson, Shirlene Anne
Malaban, Kelvin
Submitted to:
Maam Genevieve Dizon
Sir Jeshua Caleb Miole
HEMA2A Laboratory Professors
GUIDE QUESTIONS
1. What possible condition does the patient present with?
The possible condition of the patient is Paroxysmal Cold Hemoglobinuria (PCH). It is
an acute form of cold-reactive hemolytic anemia and may be idiopathic or secondary.
Paroxysmal cold hemoglobinuria is the least common type of AIHA. It is transient
and self-limiting but can produce serious hemolysis of erythrocytes. It occurs almost
exclusively in children in association with viral disorders. Erythrocyte destruction is
the result of a cold-reacting, IgG autoantibody termed autohemolysin.
acute fever
malaise, and back, leg, and/or abdominal pain 1 to 2 weeks after an upper
PCH is severe but self-limited and resolves in several days to a few weeks
with an excellent prognosis. In most patients, the anemia is severe and can
be life-threatening, so transfusion is usually needed until the symptoms
resolve.
The mainstay of treatment for paroxysmal cold hemoglobinuria is supportive
needs to be replenished.
Administer warmed, packed RBC transfusions for life-threatening hemolysis
and symptomatic anemia. Utilizing washed RBC units has not been proven to
improve transfusion safety, but this can be performed if patient's condition
PERTINENT INFORMATION
Donath-Landsteiner test
-
This is a test used to confirm the diagnosis of PCH. This involves the
collection of a fresh blood sample from a patient which is maintained at 37C.
The serum is separated into three sets of three test tubes A1-A2-A3, B1-B2B3, and C1-C2-C3. These are incubated at various temperatures with group
O RBCs that express the P antigen. In this test, 1 and 2 of each set would
contain 10 drops of patients serum and 3 would 2 and 3 would contain 10
drops of fresh normal serum as a complement source. 50% suspension of
washed P+ RBCs is added to each tube and mixed. After mixing, three tubes
are placed in an ice bath for 30 minutes and then incubated at 37C for one
hour. The three B tubes are placed in a melted ice bath for 90 minutes. The
three C tubes are kept at 37C for ninety minutes as well. After the incubating
the tubes, check for hemolysis in the supernatant.
Results:
Incubation
Tube 1
Tubes 2
Tubes 3
Phases
Ice bath followed
by 37C
Ice bath only
37C only
REFERENCES
Turgeon, M., Clinical Hematology: Theory and Procedures (Fifth Edition) p. 203
Rodak, et al., Hematology: Clinical Principles and Applications (Fourth Edition) p.
359
Harmening, Denise, Modern Blood Banking & Transfusion Practices (Sixth Edition)
p. 449-451
Steininger, et al., Clinical Hematology: Principles, Procedures, Correlations p. 274275
Turgeon, M., Immunology & Serology in Laboratory Medicine (Fifth Edition) p. 395
http://emedicine.medscape.com/article/200947-treatment (accessed 01/14/17)