A novel method for demonstrating cold agglutinin disease: a case report

Abstract

BackgroundCold agglutinin disease is a rare disorder characterized by an autoimmune hemolytic anemia occurring at low temperatures. Physical examination findings, often limited to acrocyanosis, are combined with a thermal amplitude test to help establish the diagnosis. Thermal amplitude testing determines the highest temperature at which the cold agglutination will occur and is an important parameter in diagnosing cold agglutinin disease.Case presentationHere we describe a 57-year-old white man of German and Nicaraguan descent with known chronic cold agglutinin disease who presented to our ophthalmology clinic for evaluation of a cataract. During routine cataract surgery, the lowered temperature of the conjunctiva from intermittent flow of balanced salt solution at room temperature induced a cold agglutination reaction in conjunctival vessels easily visible under a surgical microscope.ConclusionsTo the best of our knowledge, this method of demonstrating cold agglutinin disease has not been described in the literature and could easily be performed utilizing an ordinary slit lamp. This method could be used as an alternative and rapid screening method for cold agglutinin disease.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1573-7) contains supplementary material, which is available to authorized users.

Deep Hypothermic Circulatory Arrest for Emergency Repair of Type A Aortic Dissection in a Patient with Cold Agglutinins

“…Difficulty with crossmatching raised the suspicion of CA as blood matching occurred prior the initiation of bypass and DHCA. Anti-I is associated with largely viral infections as well as Mycoplasma pneumoniae, with up to 80% of patients with CAD having a previous M. pneumoniae infection (5,12,13). Both anti-I and anti-C are considered to be cold antibodies (5,12,13).…”

“…Anti-I is associated with largely viral infections as well as Mycoplasma pneumoniae, with up to 80% of patients with CAD having a previous M. pneumoniae infection (5,12,13). Both anti-I and anti-C are considered to be cold antibodies (5,12,13). Furthermore, the majority of CA are anti-I, as seen in this patient (5).…”