How Does Cold Agglutinin Disease Cause Heart Problems?

Many patients with cold agglutinin disease (CAD) develop heart problems. CAD is a rare disease in which the immune system produces antibodies against red blood cells. When exposed to cold temperatures (below body temperature), these antibodies attack the red blood cells, causing the immune system to destroy them.

Some infections can cause CAD (secondary CAD), but the disease can also develop without a known cause (primary CAD).

What heart problems are caused by CAD?

In CAD, antibodies bind to red blood cells under cold conditions, causing them to clump. These clumped cells can clog or block blood vessels. They can also increase the viscosity of the blood, essentially making the blood thicker and more “sticky.”

This increased viscosity means that the heart has to work much harder to move blood throughout the body, which can cause problems. Patients may experience symptoms such as arrhythmias, high blood pressure, cardiomegaly, heart failure, or cardiac arrest.

What can be done about heart problems in CAD?

If you have CAD, discuss with your doctor whether you are at risk for heart problems so you can manage the symptoms of CAD to help reduce this risk. Many CAD patients need to be monitored throughout their lives.

What about heart surgery for CAD patients?

Some types of heart surgery are done under hypothermic conditions. Doctors stop the heart and chill the blood and body during the surgery to reduce the amount of oxygen that tissues need.

In patients with CAD, doctors need to adjust these procedures to prevent problems from cold exposure. Patients should discuss precautions with their doctor before surgery to prevent complications.

Last updated: June 25, 2020

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