Abstract
A 51-year-old female, who had been suffered from heart failure for twenty years with no special treatment, was admitted on September 24, 1976, complaining of fever and cough of one week's duration.
On admission, there were clinical and radiological signs of pneumonia in both lung bases and mitral stenosis.
On the 8th hospital day, there occured a severe hemolytic attack with marked reticulocytosis and leuco-erythroblastosis. Examination of the sternal marrow showed a decided erythroid hyperplasia.
Cold agglutinin was present in a titer of 1 to 2,048, CF titer for Mycoplasma pneumoniae was 1 to 64, and IHA titer was 1 to 80. Cold agglutinin appeared to have specificity within the Pr-complex, which reacted with adult I and cord i cells strongly and equally.
There was no improvement in her condition by prednisolone and antibiotics.
Two weeks after admission, anemia rather aggravated with the findings of pancytopenia including reticulocytopenia, and hemorrhagic tendency developed.
On the 35th days, sudden death was caused by ventricular fibrillation.
Autopsy findings showed marked hypoplasia in the bone marrow, hemorrhage in all visceral organs and mitral stenosis of unknown origin.
The possible relationship between immune hemolytic anemia and bone marrow aplasia was discussed.
