Cold agglutinin sickness is an uncommon disorder that affects 1 per million people annually. It is usually associated with hemolytic anemia. The etiology of CAD is centered on autoantibodies known as Cold Agglutinin (CA’s), named for their ability to induce erythrocytes agglutination at temperatures below 37°C.Cold agglutinin disease is an uncommon type of autoimmune hemolytic anemia induced by cold – reacting autoantibodies. Autoantibodies that attach to the erythrocytes membrane and cause premature erythrocyte destruction define autoimmune hemolytic anemia. The examination of specimens obtained from individuals with cold auto immune hemolytic anemia is a difficult task for an automated analyzer. Cold Agglutinin Disease (CAD) is a rare autoimmune hemolytic anemia caused by IgM autoantibodies that agglutinate red blood cells (RBCs) at low temperatures. These autoantibodies produce severe analytical interference in automated hematology analyzers, frequently resulting in deceptive results such as falsely low RBC counts, high MCV, increased MCHC, and aberrant histograms. This case study involves a 42-year-old male who arrived to the laboratory with a minor fever and fatigue. Initial CBC results appeared conflicting and clinically implausible, necessitating further investigations. A visual evaluation of the blood sample showed that it seemed gritty, and a microscopic analysis showed that the RBCs were clumping together. Temperature-dependent RBC clumping was confirmed when all parameters returned to normal after the EDTA Sample was warmed to 37°C and the CBC was repeated. The diagnosis of CAD was confirmed by additional laboratory testing, such as the Direct Coombs test and cold agglutinin titers. In order to prevent diagnostic errors, this research highlights the significance of identifying analyzer flags, doing manual microscopy, and putting corrective measures in place. It highlights the need of combining clinical and laboratory evidence in diagnosing CAD.
Ms. Deepti Lodhi (Thu,) studied this question.