SHM Converge Scientific Abstract ePoster Gallery-A Cold Conundrum: Decrypting a Case of Cold Agglutinin Anemia

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This case describes a 43-year-old woman with asthma, hypertension, and obesity who presented with cough, sore throat, dyspnea, jaundice, pallor, and livedo reticularis. Initial labs showed leukocytosis, anemia, and thrombocytosis, with worsening hemoglobin in the emergency department. Chest CT showed right lower lobe consolidation, and she was treated empirically for community-acquired pneumonia. However, warming RBC transfusions provided limited benefit, raising concern for hemolytic anemia.<br /><br />A broad workup supported cold agglutinin disease (CAD): direct antiglobulin test positive, very high cold agglutinin titer, cold IgM autoantibody positivity, and blood smear showing agglutinated RBCs. Infectious evaluation for common secondary causes, including Mycoplasma, EBV, Lyme, Babesia, ehrlichiosis, and anaplasma, was unrevealing. Autoimmune testing was negative, and flow cytometry did not show leukemia or lymphoma. These findings led to a diagnosis of primary CAD after secondary causes were excluded.<br /><br />She improved significantly after short-term high-dose prednisone and IVIG, which served as a bridge while awaiting definitive therapy. She was discharged without further transfusion needs and later received bendamustine-rituximab as outpatient treatment.<br /><br />The report emphasizes that CAD is a rare autoimmune hemolytic anemia that may be primary or secondary to infection, autoimmune disease, lymphoproliferative disorders, or solid tumors. Objective data are essential for distinguishing primary from secondary CAD. Management includes temperature avoidance, acute stabilization with IVIG and corticosteroids in severe cases, and rituximab-based therapy for longer-term control. The authors also highlight the increased risk of venous thromboembolism in CAD and the importance of considering prophylaxis and folic acid supplementation.

Asset Subtitle

Samantha Lee

Meta Tag

Author List Cindy Le, Hannah M. Hamad, Megna Trivedi, Samantha Lee

Category Clinical Vignettes

Concept Cold Agglutinin Disease

Concept Primary Cold Agglutinin Hemolytic Anemia

Concept Secondary Cold Agglutinin Hemolytic Anemia

Concept Temperature Management

Concept Rituximab

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Chan Medical School

Presenting Author Samantha Lee

Track Adult

Keywords

cold agglutinin disease

autoimmune hemolytic anemia

hemolysis

direct antiglobulin test

cold agglutinin titer

IgM autoantibody

bendamustine-rituximab

IVIG

prednisone

venous thromboembolism

Cold Agglutinin Disease

Primary Cold Agglutinin Hemolytic Anemia

Secondary Cold Agglutinin Hemolytic Anemia

Temperature Management

Rituximab