Paroxysmal Cold Haemoglobinuria: A Chilling Case of Acute Renal Failure.

We describe a rare case of a 64-year-old man with acute renal failure secondary to paroxysmal cold haemoglobinuria (PCH), presenting with haemoglobinuria, jaundice, and fevers. PCH is an intravascular haemolytic anaemia with polyphasic IgG antibody binding of red blood cells at cold temperatures, with complement-mediated haemolysis on rewarming. Renal biopsy confirmed acute tubular necrosis without thrombotic microangiopathy. The patient received supportive management including intermittent haemodialysis with a warm circuit to prevent further haemolysis and achieved full renal recovery. Optimal therapy of PCH varies in the literature.