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[Remission of cold agglutinin disease following splenectomy]
M R Clemens1, P Hanfland, U Feine
1Abteilung Innere Medizin II, Medizinische Universitätsklinik und Poliklinik, Tübingen.
An anaemia (haemoglobin content 8.3 g/dl) of undetermined cause, accompanied by mild jaundice and nocturnal leg oedema, developed in a 68-year-old woman who also had an increased erythrocyte sedimentation rate (128/135 mm). Primary cold-agglutinin anaemia was established as the cause. After administration of prednisone (2 mg/kg body-weight daily), cyclophosphamide (up to 150 mg daily) and plasmapheresis (twice weekly) had failed to bring about improvement, splenectomy achieved a clear reduction of haemolysis. At last examination the haemoglobin content had risen to 12 g/dl. This report demonstrates that in individual cases splenectomy may be useful, but it needs to be determined first by radioisotope study whether the spleen is in fact the main site of erythrocyte sequestration.
An anaemia (haemoglobin content 8.3 g/dl) of undetermined cause, accompanied by mild jaundice and nocturnal leg oedema, developed in a 68-year-old woman who also had an increased erythrocyte sedimentation rate (128/135 mm). Primary cold-agglutinin anaemia was established as the cause. After administration of prednisone (2 mg/kg body-weight daily), cyclophosphamide (up to 150 mg daily) and plasmapheresis (twice weekly) had failed to bring about improvement, splenectomy achieved a clear reduction of haemolysis. At last examination the haemoglobin content had risen to 12 g/dl. This report demonstrates that in individual cases splenectomy may be useful, but it needs to be determined first by radioisotope study whether the spleen is in fact the main site of erythrocyte sequestration.