Management of cold agglutinin immune hemolytic anemia in pregnancy.
BACKGROUND
Cold hemagglutinin disease is an acquired autoimmune hemolytic anemia caused by an immunoglobulin M autoantibody directed against the polysaccharide antigens on the red blood cell surface. This case presents the challenges surrounding the management of cold hemagglutinin disease in pregnancy.


METHODS
A pregnant woman in her thirties with type-2 diabetes, reporting shortness of breath and productive cough, was found to have anemia, reticulocytosis, bilirubinemia, positive direct Coombs test result, positive cold agglutinin antibody, and raised lactate dehydrogenase levels. As the infection screen and autoimmune serology results were negative, she was diagnosed as having idiopathic cold hemagglutinin disease. The management included keeping the patient warm and hydrated and treating the anemia with warm packed red blood cell transfusion.


CONCLUSIONS
Cold hemagglutinin disease is a rare condition. Investigations to rule out infections help determine the diagnosis of cold hemagglutinin disease of unknown origin.
Dhingra
Simi
S
Department of Obstetrics and Gynecology, Royal Gwent Hospital, Newport, United Kingdom. sdhingra@doctors.org.uk
Wiener
J J
JJ
Jackson
Helen
H
D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000628:therapy*; D001323:Autoantibodies / Q000032:analysis / Q000097:blood; D003080:Cold Temperature; D003298:Coombs Test; D003450:Cryoglobulins / Q000032:analysis / Q000276:immunology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D017707:Erythrocyte Transfusion / Q000379:methods*; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis / Q000097:blood; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis / Q000628:therapy*; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000628:therapy
D001323:Autoantibodies; D003450:Cryoglobulins; D007075:Immunoglobulin M; C029443:cold agglutinins