Geissler R G, Köbberling J
Medizinische Klinik des Ferdinand-Sauerbruch-Klinikums, Wuppertal.
Klin Wochenschr. 1988 Apr 1;66(7):277-83. doi: 10.1007/BF01727512.
Cold agglutinin disease is a normo- or macrocytic anemia due to antibodies, active under body temperature, mostly belonging to the immunoglobulin class M. Initially the agglutination of erythrocytes with acrocyanosis is reversible at body temperature. High antibody activity or long lasting period of coldness lead to intravascular or intrahepatic hemolysis, but high risk anemia is rare. Beside the idiopathic form, infection induced (especially infectious mononucleosis, cytomegalovirus, Mycoplasma pneumoniae, Klebsiella), and drug induced (especially quinidine, alpha methyldopa, penicillin, para-aminosalicylic acid, various analgetics, sulfonylurea), tumor associated (especially malignant lymphomas), and autoimmune disease associated (especially systemic lupus erythematosus) cold agglutinin anemias are discribed. "Cross reacting antigenity" to the hemolysing agent and the membrane of erythrocyte, exogenous induced changing of erythrocytic antigenity, and diversification concerning the production of antibodies are discussed as pathophysiological explanations.
冷凝集素病是一种正细胞或大细胞性贫血，由在体温下具有活性的抗体引起，这些抗体大多属于免疫球蛋白M类。最初，红细胞凝集伴发绀在体温下是可逆的。高抗体活性或长时间寒冷会导致血管内或肝内溶血，但高风险贫血很少见。除特发性形式外，还描述了感染诱发（尤其是传染性单核细胞增多症、巨细胞病毒、肺炎支原体、克雷伯菌）、药物诱发（尤其是奎尼丁、α-甲基多巴、青霉素、对氨基水杨酸、各种镇痛药、磺脲类）、肿瘤相关（尤其是恶性淋巴瘤）以及自身免疫性疾病相关（尤其是系统性红斑狼疮）的冷凝集素贫血。作为病理生理学解释，讨论了对溶血剂和红细胞膜的“交叉反应抗原性”、外源性诱导的红细胞抗原性变化以及抗体产生的多样性。
