Cold Agglutinin Disease
An 87-year old woman was admitted to emergency department troubled by several weeks of fatigue and a weeklong feeling of coldness in her fingers which were starting to blacken.The diagnosis of Cold Agglutinin Disease was made. Treatment was commenced with prednisolone 40 mg and plasmapheresis and continued with a weekly rituximab and low-dose cyclophosphamide administered orally due to the high age of the patient. In spite of the therapy, the finger necrosis progressed to 0,5cm and hand surgeons were contacted to follow the development of gangrene. Cold agglutinin disease is an autoimmune disease characterized by the presence of high concentrations of circulating antibodies, usually IgM, directed against red blood cells. It is a form of autoimmune hemolytic anemia, specifically one in which antibodies only bind red blood cells at low body temperatures, typically 28–31 °C. . Credit: V. Lazarevic MD, Department of Hematology, Lund University Hospital, Lund
