Cold Agglutinin Disease - Case Report

Cold antibody autoimmune hemolytic anemia is a rare subtype of hemolytic anemia, mainly in pediatric patients. In this subtype of anemia, the immune system produces antibodies called cold agglutinins, which hemolyze red blood cells, especially in the presence of low temperatures. The disease can have primary or secondary etiology and the main symptoms include pallor, lethargy, jaundice and fever. Treatment varies according to the degree of anemia and severity of symptoms, with thermal control being highlighted. Plasmapheresis can be one of the therapeutic modalities, reserved for refractory cases that did not respond to transfusion; plasmapheresis, although common among adults, is not frequent in pediatrics. This type of hemolytic anemia in children is described as a mild and self-limiting clinical condition, but this report describes the evolution of an 8-year-old patient, who initially presented a frustrating and nonspecific clinical condition. The patient presented an unfavorable clinical evolution with significant anemia, diagnosed with hemolytic anemia due to cold antibodies, refractory to treatment with plasmapheresis and requiring the use of rituximab, reinforcing the importance of this report.