Paroxysmal cold hemoglobinuria in an elderly patient: A rare case with poor prognosis

Abstract

Introduction: Paroxysmal cold hemoglobinuria (PcH) is a very rare type of cold-mediated autoimmune hemolytic anemia causing direct intravascular hemolysis and hemoglobinuria, typically after exposure to cold. the reaction is caused by an IgG antibody known as DonathLandsteiner (D-L), which binds specifically to the P antigen of red blood cells at low temperatures, leading to complement activation and red cell lysis. case report: We report a case of rare occurrence of acute syphilitic paroxysmal cold hemoglobinuria in an elderly female with evidence of intravascular hemolysis complicated with peripheral gangrene and multiple organ dysfunctions. conclusion: the prognosis of PcH associated with syphilis is usually considered excellent and benign. However, we encountered a syphilitic PcH in an elderly female with a grave prognosis who passed away within five months after her first episode. based on our case experience, we recommend that acute episodes of PcH in an elderly patient should be treated in a closely monitored setting with high dose of steroids and warm blankets.