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Correspondence © 1986 S. Karger AG, Basel 0001-5792/86/0754-0241 $2.75/0 A ctahaem at. 75: 241 (1986) Autoimmune Haemolytic Anaemia Associated with Rheumatoid Arthritis and Paroxysmal Nocturnal Haemoglobinuria D. Maharaj Royal Infirmary, Glasgow, UK Forman et al. [1984] have described 2 patients with Immunohaematological studies revealed strongly paroxysmal nocturnal haemoglobinuria (PNH) and positive direct Coombs’ test with broad-spectrum an autoimmune haemolytic anaemia. More recently, tiglobulin serum. Further studies with monospecific Conti et al. [1985] described a patient with PNH with antiglobulin serum revealed an IgG- and C3d-coating autoimmune haemolytic anaemia and autoimmune on the patient’s cells. The eluate prepared from the thrombocytopenia. I would like to report a patient patient’s erythrocytes had anti-c rhesus specificity. with PNH and autoimmune haemolytic anaemia as Ham’s test, sucrose lysis test and insulin test were all positive. sociated with rheumatoid arthritis. An 82-year-old lady originally presented in June The patient has refused treatment with steroids be 1976 with aplastic anaemia confirmed by bone mar cause of previous side-effects, she is therefore receiv row biopsy. She was treated with regular red cell ing regular red cell transfusions of washed cells. In transfusions and oxymetholone 150 m g/day, and a addition, she is taking oral iron and folic acid. Evi partial remission was achieved after 6 months. Oxy dence of continuing mild haemolysis persists. metholone had to be stopped because of the unaccept This is another case of a rare association between able side-effect o f hirsuitism, but in spite of this, par PNH and autoimmune haemolytic anaemia o f which tial remission was maintained. In May 1980, the lady only 3 cases have so far been described. Further stud developed seropositive rheumatoid arthritis affecting ies are required to determine the incidence of autoim mainly the hands and knees. She subsequently re mune disorders in PNH patients. quired regular red cell transfusions for an unex plained iron deficiency anaemia. In July 1985, she developed haemoglobinuria and References was admitted for further investigation. Examination Forman, K.; Sokol, R.J.; Hewitt, S.; Stamps, B.K.: Paroxysmal noc revealed pallor, mild jaundice and typical rheumatoid turnal haemoglobinuria. A clinicopathological study o f 26 joint deformities of her hands and knees. The spleen cases. Acta haemat. 71: 217-226(1984). was moderately enlarged. Conti, L.; Iurlo, A.; G andolfo, G.M.; Girelli, G.: Evans syndrome Investigations: Hb 6.5 g/dl, WBC 3 .8 x l 0 9/ l, in paroxysmal nocturnal haemoglobinuria. Acta haemat. 73: platelets 100 x 109/1, reticulocyte count 14%. Periph 210-211 (1985). eral blood film showed spherocytosis and poly- chromasia. Bone marrow biopsy showed reduced cellularity with absent iron stores. Biochemistry: total bilirubin 50 ¿rmol/1, direct bilirubin 9 /imol/1, AST Accepted: May 13,1986 34 U /l, ALT 16 U /l, LDH 2, 160 U /l. Immunoglobu lins were normal. Plasma haemoglobin was elevated Dr. D. M aharaj, at 99 mg/1 with absent serum haptoglobin, and uri Senior Registrar in Haematology, nary haemosiderin was positive. Rheumatoid and an Royal Infirmary, Glasgow G4 0SF (UK) tinuclear factors were positive.
Acta Haematologica – Karger
Published: Jan 1, 1986
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