Unusual evolution to immunoblastic lymphoma of a case of Waldenström macroglobulinemia presenting with thrombocytopenia.

IgG3 type. The hematic and serous blood group was identified as 0 Rh positive; anti-DNA and ANA antibodies were negative. Viral serology demonstrated IgM anti-varicella antibodies, anti-HIV, CMV, infectious mononucleosis and hepatitis serelogy was negative. An immunohematological study carried out at the regional transfusion center showed the 3+/4+ positivity for the direct Coombs’ test with the antibody type corresponding to an IgG3. A search for allo-antibodies was negative. Elution of the autoantibody showed anti-DC specificity (concentration <1/128). The patient’s genotype, determined by saline monoclonal sera, was CDe/CDe. Variants of the D antigen were ruled out using a panel of anti-D monoclonal sera. The patient required a transfusion of two concentrates of O group Rh negative erythrocytes. Cross tests were negative in the saline and Coombs’ phase. The transfusion was carried out under intensive care, without provoking an acute hemolytic reaction. Corticold treatment at a dose of 2 mg/kg/day was begun and produced a progressive rise in the hemoglobin (14 gr/dL). At that time, the patient still showed slight hemolysis making it necessary to continue corticoid treatment. Abdominal CT documented the persistence of moderate splenomegaly and erythrokinetics evidenced shortened average erythrocyte survival (12 days) with a pattern of splenic sequestration. Splenectomy was performed and the patient’s clinical coursehas been satisfactory. He currently maintains a normal hemoglobin level with no treatment at all.