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Case 2: Autoimmune Hemolytic Anemia Gwendolen was a healthy 34-year-old. During mid-winter, after developing a feverish cough, her symptoms got worse. A doctor noted that she was very pale, especially in the palms of her hands, which were completely white. She had a fever and a high respiratory rate. Her hematocrit and hemoglobin were both low. Her white blood cell count was elevated with an increase in neutrophils. Her chest x-ray showed a patchy infiltration characteristic of walking pneumonia, Mycoplasma pneumonia. A blood sample was tested for the presence of autoantibodies against the red blood cells. In the presence of an anticoagulant, the blood coagulated at 4°C but dispersed at 37°C, a process called cold agglutination. A direct Coombs test was negative using antibodies IgG but positive when an antibody to complement protein C3b was used. What is the significance of the increase in white blood cells, particularly neutrophils? What is cold agglutination? What does it indicate about her disease? She is producing IgM antibodies against 1 antigen. What is this antigen? Would she still have an autoimmune disease if she was producing IgA or IgE antibodies? Why? What was the role of Mycoplasma pneumoniae infection in the induction of her autoimmune disease?

          Case 2: Autoimmune Hemolytic Anemia

Gwendolen was a healthy 34-year-old. During mid-winter, after developing a feverish cough, her symptoms got worse. A doctor noted that she was very pale, especially in the palms of her hands, which were completely white. She had a fever and a high respiratory rate. Her hematocrit and hemoglobin were both low. Her white blood cell count was elevated with an increase in neutrophils. Her chest x-ray showed a patchy infiltration characteristic of walking pneumonia, Mycoplasma pneumonia. A blood sample was tested for the presence of autoantibodies against the red blood cells. In the presence of an anticoagulant, the blood coagulated at 4°C but dispersed at 37°C, a process called cold agglutination. A direct Coombs test was negative using antibodies IgG but positive when an antibody to complement protein C3b was used. What is the significance of the increase in white blood cells, particularly neutrophils? What is cold agglutination? What does it indicate about her disease? She is producing IgM antibodies against 1 antigen. What is this antigen? Would she still have an autoimmune disease if she was producing IgA or IgE antibodies? Why? What was the role of Mycoplasma pneumoniae infection in the induction of her autoimmune disease?

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