{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T05:11:01Z","timestamp":1697346661475},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,1,30]],"date-time":"2007-01-30T00:00:00Z","timestamp":1170115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2007,3]]},"abstract":"<jats:p><jats:bold>BACKGROUND:<\/jats:bold> Cold hemagglutinins are generally immunoglobulin\u2003M (IgM) \u03ba antibodies reactive at temperatures below 37\u00b0C and if of high titer may cause hemolysis. Platelet (PLT) cold agglutinins (CAs) are rare and poorly characterized. A detailed molecular characterization of the variable domains of a pathologic, PLT\u2010reactive, CA is presented.<\/jats:p><jats:p><jats:bold>CASE REPORT:<\/jats:bold> A 70\u2010year\u2010old woman was admitted with rectal bleeding accompanied by widespread petechiae, bruising, tongue and buccal mucosa bleeding, and epistaxes and proved refractory to HLA\u2010 and HPA\u2010matched PLTs. Detailed investigation showed monoclonal heavy\u2010chain gene rearrangement with an IgM paraprotein of 3.3\u2003g per L and a trace of \u03ba Bence Jones protein in the urine, compatible with a diagnosis of secretory B\u2010cell non\u2010Hodgkin's lymphoma (B\u2010NHL). PLT antibody (PAIg) investigations revealed a potent IgM \u03ba PLT CA. Sequencing of the rearranged variable domain genes of the malignant clone together with idiotype\u2010specific antibodies obtained by DNA\u2010based immunization of rabbits and matrix\u2010assisted laser desorption\/ionization\u2013time\u2010of\u2010flight analysis of the PAIgM provided a irrefutable link between the thrombocytopenia, the IgM paraprotein, and the PAIgM against \u03b1IIb\u03b23. The thrombocytopenia and bleeding were refractory to standard treatment and PLT transfusion, but treatment with rituximab resulted in a recovery of the PLT count and a complete remission of B\u2010NHL.<\/jats:p><jats:p><jats:bold>CONCLUSION:<\/jats:bold> The IgM \u03ba paraprotein derived from the malignant B\u2010cell clone was a potent and clinically significant CA against \u03b1IIb\u03b23. The testing for PLT CAs in patients with a paraprotein and refractory to matched PLTs may aid the selection of appropriate treatment.<\/jats:p>","DOI":"10.1111\/j.1537-2995.2006.01142.x","type":"journal-article","created":{"date-parts":[[2007,2,2]],"date-time":"2007-02-02T18:19:31Z","timestamp":1170440371000},"page":"499-510","source":"Crossref","is-referenced-by-count":2,"title":["Molecular characterization of the variable domains of an \u03b1IIb\u03b23\u2010specific immunoglobulin\u2003M \u03ba platelet cold agglutinin in a follicular lymphoma patient with treatment refractory autoimmune thrombocytopenia: idiotypic overlap between \u03b1IIb\u03b23 integrin antibodies"],"prefix":"10.1111","volume":"47","author":[{"given":"Nicola S.","family":"Jennings","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian J.","family":"Harmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prachi","family":"Stafford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham A.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Metcalfe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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