Necrosis secondary to cold agglutinin disease.

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Date: Apr. 11, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 14)
Publisher: CMA Impact Inc.
Document Type: Clinical report
Length: 582 words
Lexile Measure: 1340L

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An 80-year-old man presented to our clinic with a 7-month history of purple discoloration, numbness and pain of the left third and fourth digits (Figure 1A). His other hand and his feet were unaffected. The discoloration was exacerbated by cold exposure but did not return to normal colour or show paroxysmal pallor, ruling out Raynaud phenomenon. He had a history of well-controlled diabetes, was not hypertensive and did not smoke. His body mass index was 19.7.

Laboratory investigations were as follows: hemoglobin 10.6 (normal 13.5-17.6) g/dL, reticulocyte count 6.4% (normal 0.6%-2.0%), indirect bilirubin 1.2 (normal 0.2-0.9) mg/dL, lactate dehydrogenase 514 (normal 106-211) IU/L, reduced haptoglobin, elevated immunoglobulin M (IgM) 526 (normal 33-190) mg/dL, hemagglutination on blood smear (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.211570/tab-related-content) and normal leukocyte count. A direct Coombs test was anti-C3 positive and cold agglutinin titre was 1:8192 (normal < 64) at 4[degrees]C....

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Gale Document Number: GALE|A699623532