Occupational Medicine Advance Access published online on March 21, 2008
Occupational Medicine, doi:10.1093/occmed/kqn031
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Case report |
Cold haemagglutinin disease misdiagnosed as hand–arm vibration syndrome
Abstract A patient with a diagnosis of hand–arm vibration syndrome was referred for a second opinion. He worked as a multi-skilled operative in the housing department of a local authority, a job not normally associated with high levels of exposure to hand-transmitted vibration (>2.5 m/s2 A(8)). He described blanching of his fingers and a blue discolouration of his extremities in cold weather. On examination, his fingertips, toes and pinnae were acrocyanotic, the fingers were patchily pale and sensation was subjectively impaired in all of the digits. Investigations revealed a haemolytic anaemia and haemagglutination. He was diagnosed with idiopathic cold haemagglutinin disease. Exposure to vibration may confound with exposure to cold in which case the differential diagnoses of cold haemagglutinin disease or cryoglobulinaemia should be excluded before diagnosing hand–arm vibration syndrome.
Keywords Acrocyanosis; cold haemagglutinin disease; hand–arm vibration syndrome
Correspondence to: Dr C. J. M. Poole, Occupational Health Service, Dudley NHS PCT, Health Centre, Cross Street, Dudley, West Midlands DY1 1RN, UK. Tel: +44 1384 366270; fax: +44 1384 366422; e-mail: jon.poole{at}dudley.nhs.uk