Cold Agglutinin Disease: A Transfusion Perspective!!

Cold agglutinin disease is a type of auto immune hemolytic anemia characterized by cold agglutinins which were first described by Landsteiner in 1903. The implicated autoantibodies are IgM type which bind to red blood cells (I, i, H antigen) at lower or colder temperatures leading to hemolysis. The hemolytic potential of such antibodies is usually determined by their titer, specificity and thermal amplitude. In this case, 31 year old female presented with fever, severe pallor and jaundice in a cold winter night. The samples were sent to Department of Transfusion Medicine to provide compatible blood units for transfusion in view of severe anemia. Visible agglutinates in anticoagulated sample and discrepant results in immunohematology laboratory were the first observation to suspect cold agglutinins. The resolution of same was done with simple pre-warming technique using conventional tube test. High titers correlated with severity of symptoms due to hemolysis. The compatible blood units obtained were transfused with special precautions and transfusion was uneventful. This case highlights the importance of simple step of maintaining blood sample of patient of cold antibodies at 370C and using conventional tube technique for immunohematological tests.