Rare Co-occurrence of CAD and Blood Disorder Reported

Marisa Wexler MS avatar

by Marisa Wexler MS |

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The case of a man with cold agglutinin disease (CAD) co-occurring with a blood cell disorder called myelodysplastic syndrome was described in a recent report from India.

The report, “Cold autoimmune hemolytic anemia with myelodysplastic syndrome: Not just an ‘Open and Shut case,” was published in the Indian Journal of Pathology and Microbiology.

Myelodysplastic syndrome, or MDS, is a group of disorders in which blood cells are not produced properly in the body. New blood cells normally are being produced continually in the bone marrow. In MDS, however, the cells that are made are defective and die prematurely. This ultimately results in too few blood cells in the body, which can cause symptoms such as fatigue.

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As many as one of every five people with MDS has a co-occurring autoimmune disorder. Autoimmune hemolytic anemias (AIHAs) — diseases where the body’s immune system erroneously attacks and destroys red blood cells — are a rare complication of MDS, occurring in about 3% of the cases. CAD, a specific type of AIHA caused by self-targeting antibodies that attack red blood cells at cold temperatures, rarely has been reported in people with MDS.

In this report, a team of scientists in India described the case of a 76-year-old man with a history of type 2 diabetes and high blood pressure.

The patient went to the hospital complaining of fever, swelling in the lower legs, and a worsening history of breathlessness for the past three months. A month before, he had been diagnosed with megaloblastic anemia — a condition in which the bone marrow makes unusually large, immature blood cells — but had not responded to treatment.

A battery of laboratory tests were conducted. Of relevance, he showed signs of kidney injury, and the Coombs test — a test that looks for antibodies that are bound or may possibly bind to red blood cells — was positive at a range of temperatures from 4 to 37 C (about 39 to 99 F), with the strongest result generally seen at lower temperatures. Based on these findings, the patient was diagnosed with CAD.

A bone marrow biopsy also showed a number of cellular changes indicative of MDS, such as erythroid hyperplasia, or an overabundance of immature red blood cells.

The patient was treated with anti-inflammatory steroids and blood transfusions, which led to a resolution of kidney damage.

“The aim of this presentation was to highlight the rare occurrence of cold AIHA with MDS,” the researchers wrote. “An increased awareness of secondary AIHA associated with MDS may help in prompt action that can be taken for earlier recognition of autoimmune phenomena potentially, leading to more positive outcomes for patients.”