好中球過分葉を認めたク-ムス試験陰性自己免疫性溶血性貧血の1例

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An 81-year-old male was admitted to our hospital in Sept., 1980 to closely examine his anemic condition. Physical examination revealed anemia and slight jaundice. The spleen was palpable 2fb below the costal margin and the liver was also palpable 2fb. Hemoglobin was 6.8g/dl, reticulocytes 43.9%, RBC 171×104/cmm, WBC 6900/cmm and the platelets were 28×104/cmm. Serum bilirubin was 3.0mg/dl (1.3 direct reacting), haptoglobin was absent, LDH 1158 IU/1 and urine hemosiderin were weakly positive. Peripheral blood film revealed numerous spherocytes, erythroblasts and hypersegmented neutrophils. Bone marrow study revealed erythroid hyperplasia without“megaloblastoid”features. RBC survival [T1/2] was 10 days. Repeated Coombs-test with polyspecific, anti-IgG, -IgA, -IgM, -IgD, -C3 and -C4 antisera were negative. Indirect Coombs-tests with enzyme-treated red cells were also negative. Tests for non-immunologic causes of hemolytic anemia were negative. The patient was diagnosed as Coombs-negative autoimmune hemolytic anemia and, thus, was treated with 40 mg/day of prednisolone. The patient responded to prednisolone and, by the 21 st day, medication was tapered off. Two months from the onset of treatment, he went into remission and neutrophilic hypersegmentation disappeared. Serum vitamin B12 and folate were normal and other evidence indicating coexistent megaloblastic anemia could not be detected. Neutrophilic hypersegmentation might be related to the autoimmune mechanism of the disease, since hypersegmented neutrophils disappeared following the recovery from anemia.
学校法人昭和大学・昭和医学会の論文

好中球過分葉を認めたク-ムス試験陰性自己免疫性溶血性貧血の1例

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