SHM Converge Scientific Abstract ePoster Gallery-Covid-19 Associated Cold Agglutinin Hemolytic Anemia in a Pediatric Patient

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This case describes a 4-year-old previously healthy, unvaccinated-for-COVID-19 girl who developed fever, fatigue, and gross hematuria after testing positive for SARS-CoV-2. She had minimal respiratory symptoms but was found in the emergency department to have frank hematuria and laboratory evidence of hemolytic anemia and kidney involvement.<br /><br />During hospitalization, her hemoglobin dropped to 6.9 g/dL, and she required two packed red blood cell transfusions. Additional workup showed marked hemolysis, including elevated bilirubin and LDH, low haptoglobin, thrombocytopenia, and a positive direct antiglobulin test with anti-C3d positivity, consistent with cold agglutinin-mediated autoimmune hemolytic anemia. Her cold agglutinin test was negative, likely because she had recently received transfusions, but later blood bank analysis identified IgM autoantibodies to i/I antigens. ADAMTS13 activity was normal, helping exclude thrombotic thrombocytopenic purpura. Over time, her hemoglobin, platelets, renal function, and bilirubin improved without disease-specific therapy, and her fevers resolved. At outpatient follow-up, she remained afebrile with improving anemia.<br /><br />The authors note that cold agglutinin disease is an autoimmune hemolytic anemia caused by IgM antibodies that react with red blood cells at cold temperatures and can lead to hemolysis, thrombosis, or cold-induced symptoms. Infections such as Mycoplasma pneumoniae, Epstein-Barr virus, and cytomegalovirus are known triggers. COVID-19 has recently been linked to cold agglutinin disease in adults, but this report represents the first described pediatric case. The case highlights that SARS-CoV-2 infection can trigger clinically significant hemolysis even in children with otherwise mild respiratory illness.

Asset Subtitle

Weijen W. Chang

Meta Tag

Author List Eric McFeely, Kenneth Bujold, Weijen W. Chang

Category Clinical Vignettes

Concept COVID-19

Concept Cold Agglutinin Hemolytic Anemia

Concept Autoimmune Hemolytic Anemia

Concept Immunoglobulin M

Concept Complement

Distinguished Finalist

Presenter Organization Nemours Children's Hospital Florida

Presenting Author Weijen W. Chang

Track Pediatric

Keywords

COVID-19

SARS-CoV-2

cold agglutinin disease

autoimmune hemolytic anemia

hemolysis

gross hematuria

pediatric case

IgM autoantibodies

thrombocytopenia

kidney involvement

COVID-19

Cold Agglutinin Hemolytic Anemia

Autoimmune Hemolytic Anemia

Immunoglobulin M

Complement