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Autoerythrocyte Sensitization

(Gardner-Diamond Syndrome)

By David J. Kuter, MD, DPhil, Harvard Medical School;Massachusetts General Hospital Cancer Center

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Autoerythrocyte sensitization is a rare disorder affecting women. It is characterized by local pain and burning preceding painful ecchymoses that occur primarily on the extremities.

Autoerythrocyte sensitization typically occurs in white women who are experiencing emotional stress or who have concomitant psychiatric illness. Episodes of ecchymosis are painful and can occur spontaneously or after trauma or surgery. Bruising can occur on different sites of the body from where the trauma occurs. Tests of the coagulation system are normal.

In women with autoerythrocyte sensitization, intradermal injection of 0.1 mL of autologous RBCs or RBC stroma may result in pain, swelling, and induration at the injection site. This result suggests that escape of RBCs into the tissues is involved in the pathogenesis of the lesion. However, most patients also have associated severe psychiatric symptoms, and some patients self-induce purpura, which may masquerade as the syndromes.

To help distinguish the disorder from factitious illness, some clinicians suggest doing intradermal injection of autologous RBCs at one site and a separate control injection without RBCs at another. Presence of ecchymosis at the test but not the control site 24 to 48 h after injection suggests autoerythrocyte sensitization. Excoriation, which can complicate the test’s interpretation, is prevented by making both sites difficult for the patient to reach. However, this test has not been validated and is usually not recommended.

Treatment is psychiatric therapy.

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