Major colorectal surgery in a patient with cold agglutinin disease

We present the case of a 62-year-old man with severe cold agglutinin disease who underwent major colorectal surgery. Cold agglutinin disease is a condition in which auto-antibodies, usually immunoglobulin M, cause red blood cell agglutination at decreased body temperature. Haemolysis may result. Agglutination results in impaired perfusion, resulting in symptomatic Raynaud's phenomenon and acrocyanosis. Haemolysis can result in anaemia and thrombotic events caused by microvascular occlusion, in addition to haemoglobinuria and renal failure. Peri-operative hypothermia is common in all patients and may be associated with significant morbidity, but is potentially catastrophic in a patient suffering from cold agglutinin disease.