Acute Kidney Injury in a Child with Paroxysmal Cold Haemoglobinuria

Paroxysmal cold haemoglobinuria (PCH) is characterised by intravascular haemolysis mediated by the Donath-Landsteiner (D-L) antibody. It accounts for up to forty percent of all cases of autoimmune haemolytic anaemia in children. Acute kidney injury (AKI) in association with PCH, however, is very rare with only two published case reports in the paediatric literature. We report the case of a nine-year-old boy who developed AKI secondary to PCH. Supportive treatment with active warming and strict fluid management was commenced. He required two sessions of haemodialysis and two warmed red cell transfusions. Recovery was complete with normal renal profile and haemoglobin at five weeks. At twenty months he remains disease-free. This case adds to the paediatric literature describing AKI in the setting of PCH. Although AKI is a rare complication, the importance of careful monitoring of fluid status and renal function is emphasised in the setting of acute intravascular haemolysis.