P83 | Cold hands: when the warm is better
Year: 2025
Type: article
Study design: Case Report
Abstract: Premises: Cold agglutinin (CA) disease is a rare autoimmune hemolytic anemia in which the antibodies for erythrocyte surface antigens are activated by low temperatures, causing agglutination of red blood cells (RBC). Autoantibodies may be idiopathic or secondary to infection, malignancy, and other autoimmune diseases. It’s under recognized with diagnosis delay. Case report: A 76-year-old man with hypertension, presented with fatigue, lower extremities pain and dyspnea. Physical examination revealed pale skin and jaundice, no bruises, no hepatosplenomegaly, or lymphadenopathy. Lab test showed haemoglobin (hb) 6,6 g/dL, MCV 111 fl, normal white cell and platelets, high reticulocytes, bilirubin, and lactate dehydrogenase, low haptoglobin. A peripheral blood smear showed anisocytosis and poikilocytosis, RBC agglutination. DAT was positive for C3d with CA. Bone marrow study demonstrated an infiltration of low-grade B lymphoma. The patient has been treated with warmed RBC and kept in warm environment. With progressive hb increase and normal hemolysis values, we decided for follow up, without other treatment, like rituximab. Re-evaluating previous lab tests, it was noted that for some years reversible RBC agglutination was reported. Conclusions: Cold avoidance and warmed transfusions are first line therapy for CA hemolysis. CA interferes in lab tests. Informing the laboratory and ensuring the proper temperature conditions will lead to accurate results. It would be desirable to alert the physician of the presence of agglutination to prescribe the appropriate investigations.
Source: Italian Journal of Medicine
Authors: Vo Van Kha, Tran Thi Huong Ly, Pham Thi Thanh Hoa, Vo Huynh Nhu, Damas Hendriansyah, Nusratuddin Abdullah, Rudy B. Leonardy, Mardiah Tahir, Samrichard Rambulangi, Firdaus Hamid, Filomena Pietrantonio, Vera Kopsaj, Francesco Rosiello, Aurora Tomassoni, Luca Moriconi, Donatella Padua, Kiki Rizki Amelia, Efendi Lukas, Nurbani Bangsawan, Isharyah Sunarno, Retno Budiarti Farid, Sriwijaya Qadar, Rabab H. Elshaikh, Ashok Kumar Sah, Abdelrahman Mohamed Abukanna, Abdulrahman Algarni, Ammar Abdelmola, Hussam Ali Osman, Tagwa Yousif Elsayed Yousif, Elryah I. Ali, Hiba Ali, Ayman Hussein Alfeel, Thanh Long Nguyen, Victor Storm, Lam Toi Phung, Cong Thien Le, Thi Thu Ha Le, Thi Hoa Nguyen, Son Tung Vu, Thien Thang Tran, Minh Hanh Vu, Van Tuan Nguyen, Francesco Ventrella, Anna Belfiore, Antonio Greco, Franco Mastroianni, Salvatore Lenti, Domenico Ruggiero, Michele Cannone, Vincenzo Ostilio Palmieri, Massimo Errico, Giuseppe Mancia, Guido Grassi, Sverre E. Kjeldsen
Language: English
Topic: Blood groups and transfusion
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413685455