Kumaravel Kanagavelu Aravind Sunderavel, Nagumantry Sateesh K, Sagi Satyanarayana V, Oyibo Samson O
Department of General Medicine, Peterborough City Hospital, Bretton Gate, Peterborough, PE3 9GZ, UK.
Department of Haematology, Peterborough City Hospital, Bretton Gate, Peterborough, PE3 9GZ, UK.
J Med Cases. 2022 Mar;13(3):119-124. doi: 10.14740/jmc3866. Epub 2022 Mar 5.
A 27-year-old woman was admitted with a history of dry cough, breathlessness, fever, lethargy, and nausea and vomiting. On examination, she was febrile, jaundiced, and hypoxic. Blood tests revealed severe leucocytosis and severe hemolytic anemia. The chest imaging demonstrated coexisting pneumonia and pulmonary embolism. An initial blood transfusion worsened the hemolytic anemia to the point that critical care review was required. Subsequent blood tests revealed cold agglutinin hemolytic anemia due to infection. The patient's condition improved after receiving a warm-blood transfusion, antibiotics, and steroid therapy. The patient also received anticoagulant therapy for 6 months. Our case is unique in that the patient had very severe anemia and very severe leucocytosis, making us suspect a hematologic malignancy at initial presentation. This case emphasizes the importance of prompt evaluation of hemolytic anemia and the use of warm blood transfusion for cold agglutinin disease.
一名27岁女性因干咳、呼吸急促、发热、乏力以及恶心呕吐入院。检查发现她发热、黄疸且缺氧。血液检查显示严重白细胞增多和严重溶血性贫血。胸部影像学检查显示同时存在肺炎和肺栓塞。首次输血使溶血性贫血恶化，以至于需要重症监护会诊。后续血液检查显示为感染所致的冷凝集素溶血性贫血。患者在接受温血输血、抗生素和类固醇治疗后病情改善。患者还接受了6个月的抗凝治疗。我们的病例独特之处在于患者有非常严重的贫血和非常严重的白细胞增多，这使我们在初次就诊时怀疑为血液系统恶性肿瘤。该病例强调了及时评估溶血性贫血以及对冷凝集素病使用温血输血的重要性。
