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$Unique_ID{BRK03807}
$Pretitle{}
$Title{Hemoglobinuria, Paroxysmal Cold}
$Subject{Hemoglobinuria Paroxysmal Cold Donath-Landsteiner Hemolytic Anemia
Donath-Landsteiner Syndrome Immune Hemolytic Anemia Dressler Syndrome Harley
Syndrome PCH Paroxysmal Nocturnal Hemoglobinuria Cold Antibody Hemolytic
Anemia}
$Volume{}
$Log{}
Copyright (C) 1990 National Organization for Rare Disorders, Inc.
776:
Hemoglobinuria, Paroxysmal Cold
** IMPORTANT **
It is possible that the main title of the article (Paroxysmal Cold
Hemoglobinuria) is not the name you expected. Please check the SYNONYM
listing to find the alternate names and disorder subdivisions covered by this
article.
Synonyms
Donath-Landsteiner Hemolytic Anemia
Donath-Landsteiner Syndrome
Immune Hemolytic Anemia
Dressler Syndrome
Harley Syndrome
PCH
Information on the following diseases can be found in the Related
Disorders section of this report:
Paroxysmal Nocturnal Hemoglobinuria
Cold Antibody Hemolytic Anemia
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Paroxysmal Cold Hemoglobinuria is a very rare autoimmune hemolytic
disorder characterized by the premature destruction of healthy red blood
cells minutes to hours after exposure to cold. Autoimmune diseases occur
when the body's natural defenses against invading organisms (e.g.,
lymphocytes, antibodies) destroy healthy tissue for unknown reasons.
Normally, red blood cells have a life span of approximately 120 days before
they are removed by the spleen. In an individual affected with Paroxysmal
Cold Hemoglobinuria, the red blood cells are destroyed prematurely and
suddenly (paroxysmally) upon exposure to temperatures of 10 to 15 degrees
Centigrade and below.
Symptoms
Attacks of Paroxysmal Cold Hemoglobinuria can occur within minutes or up to
eight hours after exposure to cold. Symptoms may include fever, malaise,
anorexia, flank pain, pain in the back and legs, headache, vomiting,
diarrhea, mild anemia, and the passage of dark brown urine (hemoglobinuria).
This urine contains the iron-containing protein pigment of blood called
hemoglobin. The presence of hemoglobin causes the dark brown color of the
urine. Attacks of Paroxysmal Cold Hemoglobinuria may be followed by
yellowing of the skin (jaundice). There may also be enlargement of the liver
and spleen.
Causes
Most cases of Paroxysmal Cold Hemoglobinuria occur after a viral infection
such as chickenpox or mumps, or in conjunction with congenital or acquired
syphilis. Paroxysmal Cold Hemoglobinuria may also affect individuals with no
history of another disorder. In these cases the cause is unknown.
Autoimmune disorders are caused when the body's natural defenses
(antibodies, lymphocytes, etc.), against invading organisms suddenly begin to
attack healthy tissue. In individuals affected with Paroxysmal Cold
Hemoglobinuria, these attacks occur when red blood cells are attacked as if
they were a virus or bacteria. Localized exposure to cold such as washing
one's hand in cold water or drinking cold water may also trigger an attack in
some severe cases.
Affected Population
Anyone may acquire Paroxysmal Cold Hemoglobinuria. An individual with a
viral infection such as chickenpox or mumps, or anyone affected with
syphilis, is of higher risk of contracting the disorder.
Related Disorders
Symptoms of the following disorders can be similar to those of Paroxysmal
Cold Hemoglobinuria. Comparisons may be useful for a differential diagnosis:
Paroxysmal Nocturnal Hemoglobinuria is a form of anemia resulting from
defects in the membranes of red blood cells. It is characterized by the
presence of hemoglobin in the urine (hemoglobinuria) chiefly occurring at
night. Symptoms of Paroxysmal Nocturnal Hemoglobinuria include severe
abdominal or back pain occurring during the phase where the oxygen carrying
portion of the red blood cell (hemoglobin) is released from the red blood
cells (hemolysis). Other symptoms may include blood in the urine, yellowing
of the skin (jaundice) and enlargement of the liver and spleen. (For more
information on this disorder, choose "Paroxysmal Nocturnal Hemoglobinuria" as
your search term in the Rare Disease Database).
Cold Antibody Hemolytic Anemia is a rare autoimmune disorder in which red
blood cells are attacked and destroyed by the body's natural defenses in
temperatures of 15 degrees Centigrade or below. Symptoms of Cold Antibody
Hemolytic Anemia may include weakness, dizziness, headache, ringing in the
ears (tinnitus), spots before the eyes, fatigue, drowsiness, irritability or
bizarre behavior. Absent menstruation, gastrointestinal complaints,
yellowing of the skin, and enlargement of the spleen may also occur. Heart
failure or shock may result. More rarely, there may be a passing of dark
urine (hemoglobinuria). (For more information on this disorder, choose "Cold
Antibody Hemolytic Anemia" as your search term in the Rare Disease Database).
Therapies: Standard
Paroxysmal Cold Hemoglobinuria is usually corrected when the accompanying
viral infection is treated, requiring only supportive therapy, bed rest and
protection of the affected individual from cold temperatures. If the
disorder is chronic, it may respond to treatment with glucocorticoids or
immunosuppressive drugs such as cyclophosphamide. In cases where blood
transfusions are necessary, certain guidelines must be followed.
Crossmatching should be done at 37 degrees Centigrade to find compatible
units of blood, and the blood should be warmed by an online warmer to prevent
new red blood cells from being coated with antibodies and destroyed.
Therapies: Investigational
This disease entry is based upon medical information available through April
1990. Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate. Please
check with the agencies listed in the Resources section for the most current
information about this disorder.
Resources
For more information on Paroxysmal Cold Hemoglobinuria, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Heart, Lung and Blood Institute
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-4236
References
CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, M.D. et al., eds;
W.B. Saunders Company, 1988. Pp. 921.
INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown
and Co., 1987. Pp. 1059.
THE MERCK MANUAL, Volume 1, 14th Ed.: Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982. Pp. 1115.
DONATH-LANDSTEINER HEMOLYTIC ANEMIA DUE TO AN ANTI-Pr-LIKE BIPHASIC
HEMOLYSIN. W.J. Judd et al.; TRANSFUSION (September-October, 1986: issue 26
(5)). Pp. 423-425.
AN UNUSUAL DONATH-LANDSTEINER ANTIBODY DETECTABLE AT 37 DEGREES C BY THE
ANTIGLOBULIN TEST. S. Lindgren et al.; (March-April, 1985: issue 25 (2)).
Pp. 142-144.