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A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.
The patient is obese and has hypertension and depression. She takes enalapril, hydrochlorothiazide, and a selective serotonin reuptake inhibitor.
Vital signs are stable and normal, except for a heart rate of 108 beats per minute. Conjunctivae are pale and mucous membranes are moist; no oropharyngeal lesions are evident. Chest is clear, and heart is normal. An abdominal examination reveals no masses or organomegaly; bowel sounds are normal. Lymph nodes at all sites are nonpalpable, and skin is normal.
On admission, a complete blood cell count reveals a hemoglobin level of 4.9 g/dL, a hematocrit of 15.4%, a white blood cell count of 17,400/μL, and a platelet count of 404,000/μL. A chemistry profile reveals a slightly elevated serum creatinine level of 1.8 mg/dL and a blood urea nitrogen level of 26 mg/dL. Lactate dehydrogenase level is elevated at 386 U/L, and haptoglobin level is low at 8 mg/dL. Total bilirubin level is normal. Results of a direct antiglobulin test (Coombs test) are positive +2 for C3 and negative for IgG.
|Which of the following statements about this patient is most accurate?
A. She needs urgent bone marrow evaluation for the possibility of a lymphoproliferative disorder.
(answer on next page)
1. Gertz MA. Management of cold haemolytic syndrome. Br J Haematol. 2007;138:422-429.
2. Berentsen S, Beiske K, Tjønnfjord GE. Primary chronic cold agglutinin disease: an update on pathogenesis, clinical features and therapy. Hematology. 2007;12:361-370.
3. McNicholl FP. Clinical syndromes associated with cold agglutinins. Transfus Sci. 2000;22:125-133.
4. Gertz MA. Cold hemolytic syndrome. Hematology Am Soc Hematol Educ Program. 2006:19-23.