title: Case report: paroxysmal cold hemoglobinuria presenting during pregnancy.
abstract: BACKGROUND
  Paroxysmal cold hemoglobinuria is caused by a biphasic IgG autoantibody that triggers complement-mediated intravascular hemolysis. Paroxysmal cold hemoglobinuria has not previously been reported to occur in association with pregnancy.
  
  
  METHODS
  We report a case of an 18 year old female who presented in early pregnancy with acute hemolytic anemia and a positive Donath-Landsteiner antibody test. She was diagnosed with paroxysmal cold hemoglobinuria and treated supportively. Her hemolysis resolved within 6 weeks. Because maternal IgG autoantibodies can cross the placenta, the patient was monitored closely throughout her pregnancy for recurrence. The outcome of the pregnancy was successful, with no evidence of neonatal anemia or hemolysis.
  
  
  CONCLUSIONS
  This patient had a classic presentation of paroxysmal cold hemoglobinuria with rapid onset of hemolytic anemia that resolved spontaneously. To our knowledge, this is the first report of paroxysmal cold hemoglobinuria presenting during pregnancy.
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA.
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Akpoguma
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Carlisle
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lentz
keywords: Donath-Landsteiner antibody; Hemolytic anemia; Paroxysmal cold hemoglobinuria; Pregnancy