Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis.
Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis.
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DOI：
10.1155/2015/823563
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发表时间：
2015
影响因子：
--
通讯作者：
Minota S
中科院分区：
文献类型：
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作者：
Honne K;Nagashima T;Iwamoto M;Kamesaki T;Minota S
一名 57 岁男性患有类风湿性关节炎，在阿达木单抗加甲氨蝶呤治疗期间出现严重贫血。结合珠蛋白检测不到，冷凝集素阳性（1 : 2048），直接库姆斯试验阳性（仅作补充），诊断为冷凝集素病。尽管用泼尼松龙（0.7mg/kg/天，持续两周）治疗后冷凝集素滴度恢复正常（1 : 64），但患者的血红蛋白并未增加到8 g/dL以上。当使用悬浮在牛血清白蛋白中的红细胞重新检测冷凝集素时，滴度仍为阳性，为1 : 1024。此外，冷凝集素具有较宽的热振幅，因为滴度在30℃时为1 : 16，在37℃时为1 : 1。这表明冷凝集素即使在体温下也能表现出致病性。泼尼松龙剂量增加至1mg/kg/天后，患者血红蛋白迅速恢复到正常范围。使用悬浮在牛血清白蛋白中的红细胞进行的热振幅测试比检测致病性冷凝集素的标准测试更敏感。
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.