Cold Hemagglutination With Symmetric Gangrene of the Tips of the Extremities

The antigen-antibody reaction between human erythrocytes and serum in which hemagglutination is observed only at low temperatures (below 20 C.) has attracted the attention of immunologists 1 and clinicians 2 for many years. Unusual serologic features of this reaction, its association with so many diverse pathologic states (Raynaud's syndrome, acute and chronic acquired hemolytic anemias, trypanosomiasis, acute bacterial infections, cirrhosis of the liver, leukemia, pernicious anemia, lymphoblastomas and bland venous thrombosis 2a ) and its presence in low titer in at least 95 per cent of normal persons 3 have been recorded. There is only 1 report 4 of the occurrence of gangrene of the extremities due to the action of a cold hemagglutinin. In the case we are reporting gangrene was much more extensive. In the data that follow the essential characteristics of the phenomenon are presented. The differences between cold hemagglutination, panagglutination and pseudoagglutination (rouleau formation) will not be