Their Blood Ran Cold: A Case Series On Cold Agglutinin Disease

Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia. This case series describes CAD in two older adults and aims to remind the audience about it as a differential for anemia. An 86-year-old man was referred to clinic for incidental macrocytic anemia. He was asymptomatic without constitutional symptoms. He did not have personal or family history of malignancy or autoimmune diseases. Physical examination was unremarkable. On investigations, blood tests did not show any evidence of nutritional deficiencies but were consistent with haemolysis secondary to CAD (Table 1). He was planned for work up for possible multiple myeloma but declined bone marrow biopsy. He was referred to Rheumatology for hypocomplementaemia but there was no evidence of autoimmune disease. ... A 92-year-old lady was admitted to hospital for recurrent falls. She had normochromic normocytic anemia with poor appetite and unintentional weight loss of 6 kilograms over a year. Investigations confirmed haemolysis secondary to CAD. She had multiple episodes of acute drop in haemoglobin requiring blood transfusions. Oesophagogastroduodenoscopy (OGD) showed a gastric polypoidal mass and an antral ulcer without active bleeding. Histopathology showed nodular foveolar hyperplasia. In view of recurrent drops in haemoglobin, decision was made to start Rituximab. However, this was with-held as family declined further tests in line with patient’s wishes.