Cold hemagglutinin disease in the operating room

Area of Science:

• Hematology
• Immunology

Background:

• Cold hemagglutinin disease (CHD) is often diagnosed late, typically after complications arise.
• The clinical significance of cold agglutinins, particularly major complications, is frequently underestimated.

Observation:

• A patient with chronic CHD experienced an acute hemolytic crisis during a surgical procedure in a cool operating room.
• Preoperative testing revealed cold agglutinins with a positive Coombs' test for C3d.

Findings:

• The identified cold agglutinin was a high-titer monoclonal IgM-kappa antibody with anti-I specificity and broad thermal amplitude.
• This case highlights that significant complications from cold agglutinins can occur and are not merely theoretical.

Implications:

• Emphasizes the critical need for thorough preoperative assessment in patients with suspected or confirmed cold agglutinins.
• Highlights the importance of tailored perioperative management to prevent hemolytic crises in susceptible individuals.
• Underscores the potential for severe hemolytic events in cold hemagglutinin disease, necessitating increased clinical vigilance.