[Cryofibrinogenemia caused by monoclonal anti-fibrinogen antibodies].
METHODS
For nine years a 54-year-old woman had been suffering from worsening treatment-resistant cold-dependent purpura of the limbs as well as cutaneous ulcerations and arthralgia, which recently had occurred even at a even slight decrease in room temperature.


METHODS
A special form of cryofibrinogenemia was identified by affinity-chromatographic separation of a plasma cryoprecipitate. From this cryoprecipitate a monoclonal antifibrinogen antibody (IgG-kappa) was isolated which, in the cold, formed a precipitating complex with fibrinogen. Paraproteinaemia was not demonstrated by conventional serum and plasma electrophoresis. There was no evidence of neoplasma.


METHODS
Attempted treatment with steroids, fibrinolytic agents and intravenous cyclophosphamide was unsuccessful. But long-term repeated plasmaphereses and anti-immunoglobulin adsorption improved the symptoms. After 5 years of this treatment-14 years after onset of symptoms-the patient died of the consequences of fulminant pulmonary embolism.


CONCLUSIONS
To establish the diagnosis of monoclonal cryofibrinogenemia it is necessary, first, to identify the cryoprecipitate in plasma; secondly, to undertake affinity-chromatographic separation of the cryoprecipitate with subsequent analysis of its components.
Zeuner
R A
RA
II. Medizinische Klinik und Poliklinik der Universität, Kiel.
Béress
R
R
Schröder
J O
JO
Gutschmidt
H J
HJ
Christophers
E
E
Euler
H H
HH
D000911:Antibodies, Monoclonal / Q000302:isolation & purification*; D001323:Autoantibodies / Q000302:isolation & purification*; D002846:Chromatography, Affinity; D003450:Cryoglobulins / Q000276:immunology; D004351:Drug Resistance; D005260:Female; D015241:Fibrinogens, Abnormal / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D010956:Plasmapheresis; D011693:Purpura / Q000188:drug therapy / Q000276:immunology*; D012883:Skin Ulcer / Q000276:immunology
D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D003450:Cryoglobulins; D015241:Fibrinogens, Abnormal