and before specific tests became widely available, Phloridzin demonstration of CA activity was used as a diagnostic tool in Mycoplasma infections. In some patients, however, production of high titer, high thermal amplitude CA may result in AIHA which may occasionally be severe.53 56 In 295 patients with AIHA, Mycoplasma or primary atypical pneumonia was identified as the probable cause in 23.1 Conversely, the frequency of clinically significant hemolysis in patients with M. pneumoniae infection is unknown. Six of 25 patients admitted to a referral center with this type of pneumonia had hemolysis, severe in two patients and mild to moderate in four.54 In general hospitals and in the community, however, the frequency of hemolytic complications is probably much lower.
The autoantibodies are polyclonal, usually anti I specific and almost invariably proteasome inhibitors of the IgM class.56 CA titers typically range between 512 and 32000. DAT is always positive for C3d.3, 56 Most reported patients have been adults, and AIHA typically occurs during the second or third week after the febrile illness has started.56 In most published cases the onset has been sudden with pallor, jaundice and, sometimes, prostration. Intravascular hemolysis, as evidenced by hemoglobinuria, has been reported in several patients. In general, the prognosis is good and the hemolytic complication is self remitting within 4 6 weeks, although a lethal course has been described in one patient.A number of case reports have been published on CA mediated AIHA in infectious mononucleosis with confirmed Epstein Barr virus etiology.
57 60 As compared to M. pneumoniae pneumonia, however, infectious mononucleosis is an infrequent cause of AIHA, accounting for approximately 1% of the cases.1, 2 Conversely, the frequency of clinically significant hemolysis in EBV infections is unknown but probably low. Hospital based data have indicated that hematological complications, being generally mild and including several manifestations terbinex structure other than AIHA, occur in 25 50% of patients with EBV infection.59 Since patient selection will influence such figures and most individuals with infectious mononucleosis are not hospitalized, the frequency is probably much lower among patients with EBVinfection in the community. CA found in EBV infections are polyclonal and almost invariably specific for the i antigen.
57, 60, 61 The immunoglobulin class may be either IgM or IgG.60 Rheumatoid factor like IgM IgG complexes have also been reported to act as CA in single cases.60 In most Maraviroc solubility published reports, DAT has been positive for C3d only. Anti i titers are usually modest, typically at 256 512, and the hemolytic anemia is transient and generally mild.Until a decade ago, pharmacological therapy for primary CAD was largely ineffective.6, 69 Partly based on this fact and partly because the severity of the clinical features have not been appreciated, counseling has been regarded the mainstay of management.3, 6, 36 However, documentation of efficacy is mainly anecdotal.15, 70 Still, in our clinical experience, staying warm summary seems to alleviate the symptoms and can probably prevent severe exacerbations of hemolytic anemia. In particular, the head, face and extremities should be protected against cold exposure.36, 69.