Intrahepatic gas shadows in neonatal duodenal obstruction.

fractions C2, C3, and C4 are required in the warm phase, and fraction Cl is probably required in the cold phase (Hinz, Picken, and Lepow, 1961). Since the introduction of penicillin treatment for syphilis, PCH has become much less common, and an increasing proportion of cases is now seen in association with acute viral infections (Dacie, 1962). In the majority of virus-associated cases the attack of haemolysis occurs either during the prodromal stage or shortly after the clinical appearance of the infection. One patient, however, developed PCH 5 weeks after an attack of mumps (Colley, 1964): our patient developed PCH 6 weeks after measles immunization. The possibility that her mild measles-like illness 3 weeks after immunization was in fact a coincidental natural measles infection cannot be excluded, though the absence of a positive history of contact and the frequency of such reactions after immunization with live measles vaccine make this unlikely. An important difference between syphilitic and virus-associated PCH is the acute transitory nature of the latter (Dacie, 1962). The haemoglobinuria generally persists for only a few days, and may, as in our patient, have ceased before admission. The antibody disappears from the serum after a period ranging from a few days to several weeks, at which time the direct antiglobulin and Donath-Land-steiner tests become negative. However, the attack, while it lasts, may endanger life, and usually necessitates transfusion with ABO and Rhesus compatible cells, warmed to approximately 37 'C. The great rarity of P negative cells, which would be unaffected by the antibody, makes their use impracticable. The severity of haemolysis in these cases may be due to the antibody having a higher thermal range for erythrocyte sensitization (up to 25 'C in our patient) than in syphilitic cases (rarely as high as 20 °C) Summary A case of paroxysmal cold haemoglobinuria is described in a 19-month-old girl following measles immunization. Haemoglobinuria occurred during the sixth week after immunization, and was associated with a raised measles antibody titre. The autohaemolysin was a typical Donath-Landsteiner antibody, having speci-ficity within the P blood group system, but it showed the higher thermal range for erythrocyte sensitiza-tion characteristic of the acute transient variety of this disorder. (1961). Studies on immune human hemolysis. II. The Donath-Landsteiner reaction as a model system for studying the mechanism of action of complement and the role of C' 1 and C' 1 esterase. The presence of branching intrahepatic …