Secondary CAD Initially Mistaken for Blood Cancer in Patient, 27

Marisa Wexler MS avatar

by Marisa Wexler MS |

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A case of cold agglutinin disease (CAD) secondary to bacterial infection in a young woman in the U.K. was initially mistaken for blood cancer, according to a recent report.

The researchers noted that the 27-year-old patient had severe hemolytic anemia, a condition in which red blood cells are destroyed faster than they can be replaced

“A prompt evaluation of hemolytic anemia is required to assess the need for a warm blood transfusion for cold agglutinin disease,” the researchers wrote as a “learning point” in their report.

Titled “A Rare Case of Severe Hemolytic Anemia and Pulmonary Embolism Secondary to Mycoplasma pneumoniae Infection,” the report was published in the Journal of Medical Cases.

CAD can be considered primary or secondary, depending on whether it develops in association with another illness, such as an infection or cancer.

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Here, researchers in England described the case of a young woman who developed secondary CAD after contracting a bacterial infection.

The woman, who had no noteworthy medical history, went to the emergency room following 10 days of coughing, which had worsened in the prior two days. She also felt lethargic, feverish, and nauseated, with vomiting, and had noticed that her urine was unusually dark in color.

A battery of clinical and laboratory tests was carried out. Notably, chest imaging scans indicated the patient had pneumonia and pulmonary embolism — a condition that causes clots to form in lung blood vessels.

Blood analyses showed the patient also had severe anemia, or a low number of red blood cells, accompanied by severe leukocytosis and thrombocytosis — high levels of white blood cells and platelets, respectively. This combination of blood abnormalities initially led the patient’s medical team to suspect that she might have a blood cancer. However, further analyses showed no signs of cancer-like cells.

The additional tests did reveal the presence of cold agglutinins, the self-reactive antibodies that cause CAD. The woman also tested positive for infection with a bacterium called Mycoplasma pneumoniae. Secondary CAD has been reported to develop in the context of these bacterial infections, though this association has rarely been seen in patients with severe CAD.

Prior to the identification of cold agglutinins, the patient had been given a blood transfusion in an attempt to manage her anemia. However, her anemia actually worsened after the initial transfusion.

Then, after the patient was discovered to have CAD, she was given transfusions of warmed blood, which eased her anemia. She also was treated with immune-suppressing steroids, as well as antibiotics to manage the underlying infection and anticoagulants for the pulmonary embolism.

Her condition improved rapidly with these treatments, and she was soon discharged from the hospital. She was reported by the researchers to be in good health.

“Our case is unique in that the patient had very severe anemia and very severe leukocytosis, making us suspect a hematologic malignancy [blood cancer] at initial presentation,” the team wrote.

“This case emphasizes the importance of increasing awareness and clinical suspicion when faced with a similar clinical scenario and the importance of warm blood transfusion for [CAD],” they concluded.