Objective To explore the feasibility of preheating in 41 ℃ water bath for 30 minutes to correct the red blood cell parameters in the specimens containing high-titer cold agglutinins(CAs). Methods Two specimens containing high-titer CAs were selected during work,and the parameters of complete blood count at room temperature or after preheating in 37 ℃ or 41 ℃ water bath were compared.The smears were stained,and the distribution of red blood cells was observed with a microscope.Further,74 specimens without CAs were collected for complete blood count,and then the test results at room temperature and after preheating at 41 ℃ were compared. Results At room temperature,the specimens containing high-titer CAs showed significantly reduced red blood cell count(RBC)and hematocrit(HCT),abnormally increased mean corpuscular hemoglobin(MCH)and mean cell hemoglobin concentration(MCHC),abnormal percents of hemoglobin(HGB)and RBC,and aggregation of a large number of red blood cells.After being preheated at 37 ℃ for a certain time,the specimens demonstrated obviously improved parameters while still aggregation of a small number of red blood cells.After being preheated at 41 ℃ for 30 minutes,the specimens showed significantly increased RBC,normal HCT,MCH,and MCHC,and evenly distributed red blood cells.The 74 specimens without CAs showed the comparability was ≥80% between room temperature and preheating at 41 ℃ for 30 minutes or 60 minutes. Conclusion We can preheat the specimens containing high-titer CAs in a water bath at 41 ℃ to obtain accurate red blood cell parameters.
Cryoglobulins ; Erythrocyte Count ; Erythrocytes ; Feasibility Studies ; Hematocrit

Cryoglobulins are cold-precipitable monoclonal or polyclonal immunoglobulins,which can occur without an identifiable underlying disease condition or in association with underlying disorders.Cryoglobulinemic vasculitis is immune complex-mediated vasculitis that predominantly affect small vessels.Less often,medium-sized or even large vessels can be affected.Cryoglobulinemic vasculitis is a rare one of the cutaneous manifestations of multiple myeloma.We experienced a patient with cryoglobulinemic vasculitis developed in multiple myeloma who presented with Raynaud's phenomenon,purpuric patch and skin ulcer.
Cryoglobulinemia ; Cryoglobulins ; Humans ; Multiple Myeloma* ; Skin Ulcer ; Vasculitis*

OBJECTIVE: Cryoglobulins are immunoglobulins that tend to form reversible precipitations below 37degrees C, well known to be associated with various diseases such as autoimmune diseases, hematologic malignancies, chronic infections and renal diseases. In many cases, low amounts of cryoglobulins take a few days to be precipitated. In this study, we compared cryoglobulin early screening test with conventional method to evaluate its clinical efficacy. MEHTODS: 28 patients who showed cryoglobulinemia were selected and the time it took for visibly detecting the existence of cryoglobulin were recorded. Sera of cryoglobulinemiemic patients (n=19) and of control group (n=14) kept in two conditions of 37 degrees C and 4 degrees C for 1 hour and were then measured for delta optical density (DOD). RESULTS: In the cryoglobulin early screening test using the test tube, the median and range of the DOD for cryoglobulinemic patient group was 0.50 (0.17~0.99) while it was 0.18 (0.02~0.50) for the control group. The results showed statistically significant difference (p=0.001). In another method of using the microplate, there was no statistical significance between disease and control group. The area under the curve for test tube method was 0.857. The sensitivity and specificity were 89.5% and 71.4% respectively (cut-off value=0.23). CONCLUSION: Cryoglobulin early screening test provides the results within 2 hours and we thought this feature could give clinicians some helpful informations. More studies are needed in the future for increasing the sensitivity and specificity of this test.
Autoimmune Diseases ; Cryoglobulinemia ; Cryoglobulins ; Hematologic Neoplasms ; Humans ; Immunoglobulins ; Mass Screening* ; Sensitivity and Specificity

OBJECTIVE: To analyze one case of multiple myeloma (MM) initially presenting cold agglutinin syndrome (CAS), so as to improve clinical understanding and screening of this disease. METHODS: The clinical data, laboratory examination, bone marrow result, diagnosis and treatment of the patient were analyzed and summarized to provide ideas and clinical experience for the early diagnosis and treatment of CAS secondary to MM. RESULTS: The clinical manifestations of asthenia, hemolysis, jaundice and scattered livedo reticularis were caused by CAS secondary to MM, which was different from the general Raynaud's phenomenon. IgMκ type MM was definitely diagnosed according to the morphological features of bone marrow cells and immunofixation electrophoresis. After 3 courses of chemotherapy with BAD regimen and enhanced thermal support, anemia was corrected, M protein was decreased and the cold agglutinin phenomenon was significantly reduced. The evaluation of efficacy reached very good partial response. CONCLUSION There are very few MM patients with CAS as the initial presentation, so it is easy to misdiagnose. Early diagnosis and individual therapy are particularly important, which requires clinicians to observe and gain experience further.
Anemia, Hemolytic, Autoimmune/diagnosis* ; Cryoglobulins ; Early Diagnosis ; Humans ; Multiple Myeloma/diagnosis*

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, with a peak incidence at 5-14 years. Extrapulmonary manifestations occur in 20-25% of patients with M. pneumoniae infection. Most auto-antibodies that cause immune hemolytic anemia in humans are cold agglutinins. The formation of cold agglutinins is frequently observed during M. pneumoniae infections, and cold agglutinin disease usually occurs during M. pneumoniae infections. Nevertheless, severe hemolysis is exceptional. If a patient has any underlying disease related to hemolysis, it is possible to accelerate hemolysis. Hereditary spherocytosis is a common cause of hereditary hemolytic anemia resulting from red blood cell membrane defects. Hemolysis of red cells may result from corpuscular abnormalities or extracorpuscular abnormalities, such as immune or non-immune mechanisms. We report a case of hereditary spherocytosis associated with severe hemolytic anemia due to Mycoplasma pneumonia.
Agglutinins ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anemia, Hemolytic, Congenital ; Child ; Cold Temperature ; Cryoglobulins ; Erythrocytes ; Hemolysis ; Humans ; Incidence ; Membranes ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Spherocytosis, Hereditary

Pernio, or chilblains, are a localized inflammatory lesion of the skin resulting from an abnormal response to cold. The condition is characterized by cutaneous lesions located on the distal parts, such as the fingers, toes, nose and ears. Pernio develops among susceptible individuals who are exposed to non-freezing condition and most commonly occurs among young women and children. However, reports on childhood pernio are rarely found. Several conditions have been described as predisposing factors to pernio, including excessive cold exposure, low-grade vasculitis, the presence of cryoproteins, anorexia nervosa, systemic lupus erythematous and antiphospholipid antibodies. It is important, therefore, when evaluating a patient with chronic pernio who is resistant to conservative management, to exclude an underlying condition and also to determine whether additional testing is necessary. Herein, we present an uncommon case of a 5-year-old female patient with chronic pernio that may be associated with the presence of cold agglutinin. She received topical steroids prior to evaluation but no improvement was seen. Howere, treatment with calcium channel blocker, nifedipine, was of benefit to our patient.
Anorexia Nervosa ; Antibodies, Antiphospholipid ; Calcium Channels ; Causality ; Chilblains ; Child ; Child, Preschool ; Cryoglobulins ; Ear ; Female ; Fingers ; Humans ; Nifedipine* ; Nose ; Skin ; Steroids ; Toes ; Vasculitis

Early diagnosis of glomerulonephritis is important in initiating appropriate treatment and controlling chronic glomerular injury that may eventually lead to end-stage renal disease. Although many patients with glomerular disease have only renal involvement, systemic presentations are not uncommon, as frequently resulted from an underlying systemic disease or a factor such as infections, drugs, or metabolic diseases. The presence of an underlying secondary reason should be investigated in each glomerular disease independent of its histopathologic type. Laboratory tests may include C3, C4, ANA, dsDNA, antineutrophil cytoplasmic antibody titers, a streptozyme test, HBV and HCV serologies, and in some cases, blood cultures, anti-glomerular basement membrane antibodies, and cryoglobulins. Although serologic tests may be helpful in establishing a diagnosis in some patients, a renal biopsy is usually performed even if serologic testing is positive. In addition, serologic test may assist in interpretation of the renal pathology.
Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Basement Membrane ; Biopsy ; Cryoglobulins ; Diagnosis, Differential ; Early Diagnosis ; Glomerulonephritis ; Humans ; Kidney Failure, Chronic ; Metabolic Diseases ; Serologic Tests

PURPOSE: This study aimed to investigate the positive rate of 3 serologic methods and polymerase chain reaction (PCR) and the changes of IgG and IgG subclasses in children with Mycoplasma pneumoniae pneumonia (MP). METHODS: Fifty children with pneumonia admitted to Daejeon St. Mary's Hospital, Korea, during MP outbreaks were evaluated for the diagnostic antibody status using 3 serologic methods: indirect micro-particle agglutinin assay (MAA, Serodia-Myco II, Fujirebio, Tokyo, Japan), cold agglutinins and enzyme-linked immunoassay (EIA, Platelia M. pneumoniae IgM & IgG BIO-RAD, Marnes-la-Coquette, France) and PCR. The levels of antibody for MP in each method were measured 2 times during hospitalization: at presentation and at discharge (mean interval, 6.5 days). The levels of IgG and IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were also analyzed 2 times (at presentation and at discharge) using stored sera. RESULTS: At presentation, the positive rates of the diagnostic methods were 52%, 38%, 30% and 12% for MAA, cold agglutinins, EIA and PCR assay, respectively. Following analysis of the repetitive measurement of the antibody, the positive rates of the diagnostic methods were 76%, 60% and 56% for MAA, cold agglutinins and EIA, respectively. The mean IgG level of MP patients increased during hospitalization (973+/-184 vs. 1,040+/-205 mg/dL; P=0.008). Among the IgG subclasses, the levels of IgG1 and IgG3 showed a significant increase during hospitalization (553+/-129 vs. 611+/-151 mg/dL, P=0.003 for IgG1; 43+/-27 vs. 47+/-30 mg/dL, P=0.005 for IgG3). CONCLUSION: For the accurate and relatively rapid diagnosis of MP, a paired sample examination is mandatory, especially within a short-time period. The sensitivity of serologic tests for the diagnosis of MP may differ among commercially available kits. IgG1 and IgG3 appear to be the main IgG subclasses that show an increase after MP infection.
Agglutinins ; Child ; Cold Temperature ; Cryoglobulins ; Disease Outbreaks ; Hospitalization ; Humans ; Immunoassay ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Serologic Tests ; Tokyo

Cryoglobulinemia is a rare medical condition defined by presence of cryoglobulins in serum and it may cause hyperviscosity syndrome or systemic vasculitis in variable organs including the skin, joints, liver, kidneys, lungs and nervous system. A vasculitic polyneuropathy or mononeuritis multiplex commonly occurs. However, central nervous system complications of cryoglobulinemia including stroke, encephalopathy and seizures are rarely reported. We represent a case of essential cryoglobulinemic vasculitis manifested as a sensorimotor polyneuropathy combined with an acute ischemic stroke attack.
Central Nervous System ; Cerebral Infarction* ; Cryoglobulinemia* ; Cryoglobulins ; Joints ; Kidney ; Liver ; Lung ; Mononeuropathies ; Nervous System ; Polyneuropathies* ; Seizures ; Skin ; Stroke ; Systemic Vasculitis ; Vasculitis

BACKGROUNDMixed cryoglobulinemia (MC) is one of the most common and severe symptoms in chronic hepatitis C patients. The aim of this study was to investigate whether mixed cryoglobulinemia is a factor associated with sustained virological response in chronic hepatitis C patients treated with combination therapy of pegylated interferon alpha-2a and ribavirin.

METHODSThis is a single-center study including 57 chronic hepatitis C patients who received combination treatments of pegylated interferon alfa-2a and ribavirin. Serum cryoglobulin was detected by cryoprecipitation prior to treatment. Serum hepatitis C virus (HCV) RNA levels were checked before treatment, during the fourth and 12th week of treatment, and during the 24th week after cessation of treatment. The genotype of HCV was determined at baseline. Logistic regression analysis was used to assess the factors associated with sustained virological response.

RESULTSTwenty-five patients were with MC (43.9%). Twenty-four weeks after cessation of antiviral treatment, sustained virological response achievement in MC(+) patients was significantly lower than that in MC(-) patients (32.0% vs. 75.0%, P = 0.001). Univariate Logistic regression analysis and multivariate Logistic regression analysis found that only MC (odds ratio: 6.375; 95% CI: 1.998- 20.343, P = 0.002) was negatively associated with sustained virological response achievement.

CONCLUSIONMC is an independent factor negatively associated with sustained virological response in chronic hepatitis C patients treated with pegylated interferon alpha-2a and ribavirin.

Adolescent ; Adult ; Aged ; Cryoglobulinemia ; etiology ; metabolism ; Cryoglobulins ; metabolism ; Female ; Hepatitis C, Chronic ; blood ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; Recombinant Proteins ; therapeutic use ; Ribavirin ; therapeutic use ; Young Adult