Limits...
Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis.

Honne K, Nagashima T, Iwamoto M, Kamesaki T, Minota S - Case Rep Rheumatol (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi 329-0498, Japan.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Clinical course of the patient and hemoglobin levels. ADA: adalimumab; Hb: hemoglobin; MTX: methotrexate; PSL: prednisolone (mg/day).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4543590&req=5

fig1: Clinical course of the patient and hemoglobin levels. ADA: adalimumab; Hb: hemoglobin; MTX: methotrexate; PSL: prednisolone (mg/day).

Mentions: A 57-year-old man had an 8-year history of RA and had been treated with methotrexate for 6 years. Biweekly injection of adalimumab had been started 6 months earlier to suppress disease activity. He showed a good response to adalimumab and achieved clinical remission. After seven doses, adalimumab and methotrexate were both suspended due to upper respiratory tract infection. One month later, he suddenly developed severe anemia that was unresponsive to blood transfusion (Figure 1). He was then referred to our hospital for assessment.


Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis.

Honne K, Nagashima T, Iwamoto M, Kamesaki T, Minota S - Case Rep Rheumatol (2015)

Clinical course of the patient and hemoglobin levels. ADA: adalimumab; Hb: hemoglobin; MTX: methotrexate; PSL: prednisolone (mg/day).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4543590&req=5

fig1: Clinical course of the patient and hemoglobin levels. ADA: adalimumab; Hb: hemoglobin; MTX: methotrexate; PSL: prednisolone (mg/day).
Mentions: A 57-year-old man had an 8-year history of RA and had been treated with methotrexate for 6 years. Biweekly injection of adalimumab had been started 6 months earlier to suppress disease activity. He showed a good response to adalimumab and achieved clinical remission. After seven doses, adalimumab and methotrexate were both suspended due to upper respiratory tract infection. One month later, he suddenly developed severe anemia that was unresponsive to blood transfusion (Figure 1). He was then referred to our hospital for assessment.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi 329-0498, Japan.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus