ABSTRACT
We describe a patient with an acute fatal autoimmune haemolytic anaemia (AIHA) due to idiopathic cold haemagglutinins. According to the literature the dramatic course of this cold haemagglutinin disease is uncommon.
Subject(s)
Agglutinins/blood , Anemia, Hemolytic, Autoimmune/immunology , Anemia, Hemolytic, Autoimmune/therapy , Cryoglobulins , Fatal Outcome , Humans , Immunoglobulin M/immunology , Male , Middle AgedSubject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Blood Group Antigens/immunology , Adolescent , Aged , Anemia, Hemolytic, Autoimmune/immunology , Autoantibodies/isolation & purification , Female , Humans , Immunoglobulin A/immunology , Kidd Blood-Group System/immunology , Male , Rh-Hr Blood-Group System/immunologyABSTRACT
Non-artificial blood admixture in cerebrospinal fluid (CSF) can be proven by demonstrating siderophages and 'bilirubin excess'. Bilirubin excess exists when the bilirubin concentration measured in the CSF exceeds the expected CSF bilirubin concentration. The expected CSF bilirubin concentration is calculated by multiplying the serum bilirubin concentration by the albumin quotient. Given a certain method of determination, a difference between the above-mentioned concentrations of less than 0.15 mumol/l must not be regarded as excess. Bilirubin excess was exclusively found in CSF with non-artificial blood admixture. Cytological and spectrophotometric studies are sufficient in screening for non-artificial blood admixture. When there are indications of an increased bilirubin concentration, calculations should be made in order to establish whether bilirubin excess exists. Lumbar puncture within 48 hours of the suspected haemorrhage should be avoided if possible.
Subject(s)
Bilirubin/cerebrospinal fluid , Cerebral Hemorrhage/cerebrospinal fluid , Cerebrospinal Fluid/cytology , Macrophages , Cell Count , Cerebrospinal Fluid Proteins/analysis , Erythrocytes , Humans , Methods , SpectrophotometryABSTRACT
This paper evaluates demonstration of siderophages as a method of differentiating blood in CSF. Of 1147 CSF samples, 125 were selected which had been obtained by lumbar puncture from patients with proven intracranial haemorrhage (spontaneous or traumatic) after an exactly known interval since the onset of clinical phenomena (haemorrhage or accident). No siderophages were found within 24 hours; in a few cases they were found on the second or the third day, and after that time they were found in the majority of cases. This is a pathognomonic finding. Collection of CSF in successive portions, qualification of the tap by the clinician as 'traumatic' or 'atraumatic', and demonstration of crenated red cells, were found to be unreliable methods. A modified apparatus for sedimentation is described.
