Saito M, Endo O, Okazaki H, Inoue S, Takamura Y, Watanabe S
3rd Department of Internal Medicine, Yokohama City University.
Rinsho Byori. 1991 Jun;39(6):671-4.
69 year-old female. Two weeks before the admission, the patient had suffered from upper respiratory tract infection. Severe anemia was detected (Hb was 6.0 mg/dl) and she received a transfusion. Four days after the transfusion, she became icteric and was transferred to our hospital on Feb. 3, 1990 for evaluation of anemia. Laboratory data on admission are as follows; Hb 6.3 g/dl, reticulocytes 128%, total bilirubin 4.6 mg/dl, indirect bilirubin 3.4 mg/dl, urobilinogen in urine positive, WR negative, direct anti-globulin test positive, indirect of the test negative, and Donath-Landsteiner test positive (both direct and indirect). Her red blood cells were classified as P2-positive. From these findings, non-syphilitic PCH was diagnosed. She required bed rest and therapy to protect her from cold exposure. The hemoglobin recovered to 8.3 g/dl. The D-L test was positive for 9 months. This is a rare case of PCH because the patient fell ill in old age and PCH was found because of her severe anemia in spite of her unawareness of hemoglobinuria.
69岁女性。入院前两周，患者患上呼吸道感染。检测发现严重贫血（血红蛋白为6.0mg/dl），她接受了输血治疗。输血后四天，她出现黄疸，并于1990年2月3日被转至我院评估贫血情况。入院时实验室检查数据如下：血红蛋白6.3g/dl，网织红细胞128%，总胆红素4.6mg/dl，间接胆红素3.4mg/dl，尿胆原阳性，梅毒血清试验阴性，直接抗球蛋白试验阳性，间接抗球蛋白试验阴性，唐纳-兰斯泰纳试验阳性（直接和间接均阳性）。她的红细胞分类为P2阳性。根据这些发现，诊断为非梅毒型阵发性寒冷性血红蛋白尿症。她需要卧床休息并接受治疗以避免受寒。血红蛋白恢复至8.3g/dl。唐纳-兰斯泰纳试验在9个月内一直呈阳性。这是一例罕见的阵发性寒冷性血红蛋白尿症病例，因为患者发病时年龄较大，且尽管她未意识到血红蛋白尿，但因严重贫血而发现了阵发性寒冷性血红蛋白尿症。
