Paroxysmal cold haemoglobinuria of childhood: a review of the management and unusual presenting features of six cases.

We report six cases of children presenting with paroxysmal cold haemoglobinuria occurring in a 3-year period in the north-west of England. In all six cases the onset of the illness was dramatic and its duration brief. We note the prominent red cell agglutination was evident in the blood film, the absence of a prompt reticulocyte response and a negative classical direct Donath Landsteiner test in each of these cases. The Direct Coombs Test (DCT) was positive when anticomplement reagents were used but high titres of free autoantibody were not demonstrated in the serum.