Cold agglutinin syndrome: nursing management

Although cold agglutinin syndrome rarely results in an acute hemolytic episode, consideration should be given to the potential problems that exist when cold agglutinins are present. This autoimmune response may be present in an acute or chronic form. Viral and bacterial infections, especially mycoplasma pneumonia, may precipitate acute CAS, whereas, chronic CAS may be idiopathic or associated with malignant lymphoma. Both acute and chronic CAS may result in RBC hemolysis as the IgM antibody reacts with the I-antigen on the RBC, setting the complement cascade into action. Therefore, screening for cold agglutinins should be done before any procedure that would introduce cold fluids into the body, e.g., blood transfusions and cold cardioplegia during coronary artery bypass surgery.