Холодовая агглютининовая болезнь. Описание клинического случая

Abstract

The article presents a clinical case of admission, observation and treatment of a senior patient with a diagnosis: Primary (idiopathic) cold agglutinin disease. Coronary heart disease. Exertional angina pectoris. Functional class 1. One of the rather rare and non-standard diagnoses in the work of a clinical doctor on duty is presented. A spectrum of examinations of the blood from patients with this disease was presented. Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia in which immunoglobulin M antibodies bind to red blood cells and fix complement, which leads to the development of hemolysis. The study was conducted on the basis of the Chuz “Klinicheskaya Bol’nitsa “Rzhd-Meditsina” (private healthcare facility «Clinical Hospital «Russian Railways-Medicine») in Tyumen in April 2019, where in admission department a clinical case was registered which included admission, observation and treatment of a patient who have been diagnosed with: Primary cold agglutinin disease. Coronary heart disease. Exertional angina. Functional class 1. Observation and treatment of a patient with a diagnosis of Primary cold agglutinin disease was registered in the admission department. Coronary heart disease. Exertional angina. The patient did not know that she was suffering from primary cold agglutinin disease, and was never before diagnosed with it. Aim. Description of the identified case of primary (idiopathic) cold agglutinin disease for a more complete understanding of the problem due to the rarity of the disease; analysis of the possibility of early diagnosis based on the example of a specific case. Material and methods. A retrospective analysis of the medical history of a patient with a rare disease - primary (idiopathic) cold agglutinin disease was carried out. The anamnesis of life and disease, clinical, laboratory and instrumental data were assessed. An example is given from the practice of the admission department of the private healthcare facility «Clinical Hospital «Russian Railways-Medicine» in Tyumen of the clinical observation of the patient with diagnosed primary (idiopathic) cold agglutinin disease. Conclusion. This case clearly demonstrates the classic course of primary cold agglutinin disease. Due to the sudden deterioration of the condition associated with hypothermia, we see the importance of paying close attention to a thorough anamnesis taking to identify the relationship with hypothermia, and with exacerbation of the disease in cold conditions. It is also important to take into account clinical symptoms characteristic of this pathology, one of which is - livedo. Also, when planning a treatment for patients with CAD it is necessary to take into consideration the features of the course and manifestation of not only the underlying disease, but also concomitant pathology which will make it possible to carry out the corresponding laboratory and instrumental tests earlier and prescribe a rational complex therapy.