Abstract
A youth who had prodromal myalgias for 20 days developed pallor, generalized lymphadenopathy, and splenomegaly. A diagnosis of infectious mononucleosis was established by detection of atypical lymphocytes, elevated immunoglobulins, and the presence of characteristic Bunnell-Davidsohn heteroantibody. Concurrent immunohemolysis occurred, with slight reticulocytosis, bilirubinemia, and ahaptoglobinemia. The bone marrow showed proliferative erythrocytic hyperplasia but with a reduced reticulocyte production rate. 51Cr survival of autologous erythrocytes was reduced, with chiefly splenic sequestration. After 59Fe-labelled younger erythrocytes shifted from the marrow into the circulation they were hemolyzed only beyond their fourth day of reappearance. Direct antiglobulin tests of patient's erythrocytes were negative, with all antiglobulin sera except those with anti-C 3,4 specificity. The patient's serum and eluate contained a potent cold-reacting complement-binding autoantibody with blood group N specificity and increased thermal amplitude.
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