Resolution of serologic problems due to cold agglutinin mediated autoimmune hemolytic anemia and its transfusion decision

• Main Authors: Chen, L. (Author), Fu, X. (Author), He, Y. (Author), Lv, D. (Author), Mu, Q. (Author), Shi, S. (Author), Yang, J. (Author), Yang, S. (Author), Ying, Q. (Author)
• Format: Article
• Language: English
• Published: John Wiley and Sons Inc 2021
• Subjects: adult; aged; Aged; Anemia, Hemolytic, Autoimmune; antibody screening; antibody titer; Article; Autoantibodies; autoantibody; autoimmune hemolytic anemia; blood; blood group; blood transfusion; Blood Transfusion; blood transfusion decision; bone marrow suppression; cancer chemotherapy; case report; clinical article; cold agglutinin; cold agglutinins; complement component C3d; Coombs test; Coombs Test; cryoglobulin; Cryoglobulins; decision making; dexamethasone; drug megadose; emergency ward; erythrocyte; erythrocyte transfusion; Erythrocytes; female; Female; hospital admission; human; human cell; Humans; hyperbilirubinemia; hypertransaminasemia; immunoglobulin; immunology; jaundice; laparoscopy; male; Male; middle aged; Middle Aged; occult blood test; patient assessment; postoperative care; Rectal Neoplasms; rectum cancer; rectum resection; rectum tumor; reticulocytosis; rituximab; sclera disease; serologic problems; serology; skin discoloration; sodium chloride
• Online Access: View Fulltext in Publisher
• ISBN: 08878013 (ISSN)
• DOI: 10.1002/jcla.23894

Background: Autoimmune hemolytic anemia (AIHA) is a rare disease characterized by hemolysis caused by autoantibodies against erythrocyte surface antigen. These antibodies can be classified as warm, cold, or mixed types. Methods: We report two cases of cold agglutinin disease (CAD), which were eventually diagnosed owing to blood group discrepancy. Resolution was achieved after washing the red blood cells (RBCs) with warm saline and absorbing the autoantibodies at 4°C with the washed RBCs. We also assessed the patient's condition and discussed the strategy of blood transfusion. Results: The first case occurred after postoperative chemotherapy for rectal cancer, and the other manifested with anemia from the outset. Direct antiglobulin tests were positive and revealed autoantibodies against C3d only. Cold agglutinin titration was performed, and the titers of both were 1:1024. Eventually, the patient's condition stabilized without blood transfusion. Conclusion: The serological discrepancies observed in the blood transfusion department can successfully guide blood transfusion decisions in cases of CAD. © 2021 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.