SHM Converge Scientific Abstract ePoster Gallery-Cold Agglutinin

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This case describes a 72-year-old woman who presented with fevers, dysuria, jaundice, and profound anemia. Initial laboratory studies showed severe macrocytic anemia, reticulocytosis, elevated LDH and bilirubin, and peripheral smear evidence of red cell agglutination. A direct antiglobulin test was C3-positive and IgG-negative, confirming cold agglutinin disease (CAD), a complement-mediated form of autoimmune hemolytic anemia. She was treated with warmed packed red blood cell transfusions and discharged with instructions to avoid cold exposure.<br /><br />Five days later, she returned with dizziness and dyspnea and was found to be COVID-19 positive with recurrent severe anemia and bilateral deep vein thromboses. Further evaluation revealed an IgM kappa monoclonal gammopathy, and bone marrow biopsy identified a low-grade B-cell lymphoproliferative disorder. She was started on rituximab and discharged with oncology follow-up.<br /><br />The report emphasizes that CAD is often associated with an underlying clonal B-cell disorder, most commonly lymphoplasmacytic lymphoma or another indolent B-cell neoplasm. It also highlights how inflammatory triggers, including SARS-CoV-2 infection, may worsen hemolysis and reveal previously unrecognized hematologic disease. The patient’s thrombotic events underscore the prothrombotic risk associated with active hemolysis.<br /><br />Overall, the case reinforces the importance of distinguishing CAD from warm autoimmune hemolytic anemia, since corticosteroids are generally ineffective in CAD. Early diagnosis, evaluation for an underlying clonal process, and careful supportive and targeted therapy are essential for optimal management.

Asset Subtitle

Audrey Shawley

Meta Tag

Author List Audrey Shawley, Gagandeep Kaur

Category Clinical Vignettes

Concept Cold Agglutinin Disease

Concept Complement-Mediated Hemolysis

Concept Autoimmune Hemolytic Anemia

Concept Immunoglobulin M

Concept Direct Antiglobulin Test

Distinguished Non-Finalist

Presenter Organization Scripps Mercy Hospital San Diego

Presenting Author Audrey Shawley

Track Adult

Keywords

cold agglutinin disease

autoimmune hemolytic anemia

C3-positive direct antiglobulin test

macrocytic anemia

red cell agglutination

COVID-19 infection

IgM kappa monoclonal gammopathy

B-cell lymphoproliferative disorder

rituximab treatment

deep vein thrombosis

Cold Agglutinin Disease

Complement-Mediated Hemolysis

Autoimmune Hemolytic Anemia

Immunoglobulin M

Direct Antiglobulin Test