Autoimmune hemolytic anemia. 3. Cold antibody type.

Area of Science:

• Hematology
• Immunology
• Internal Medicine

Background:

• Cold autoimmune hemolytic anemia involves autoantibodies (cold agglutinins) reactive at low temperatures.
• The anti-I autoantibody is associated with cold hemagglutination disease and secondary anemias.
• Paroxysmal cold hemoglobinuria features the Donath-Landsteiner antibody, causing hemolysis upon cold exposure.

Observation:

• Anti-I cold agglutinins are prevalent in cold hemagglutination disease, lymphomas, leukemias, and atypical pneumonia.
• Infectious mononucleosis and other lymphoproliferative disorders can also present with anti-I antibodies.
• The Donath-Landsteiner antibody is a unique biphasic autoantibody specific to paroxysmal cold hemoglobinuria.

Findings:

• This article reviews cold autoimmune hemolytic anemias, focusing on cold agglutinins and the Donath-Landsteiner antibody.
• Diagnostic approaches for various cold autoimmune hemolytic anemias are presented.
• Table 4 provides a practical diagnostic strategy for autoimmune hemolytic anemias.

Implications:

• Understanding cold agglutinin types aids in diagnosing specific autoimmune hemolytic anemias.
• Differentiating between cold agglutinin disease and paroxysmal cold hemoglobinuria is crucial for appropriate management.
• This review serves as a practical guide for clinicians managing patients with autoimmune hemolytic anemias.