Detecting cold agglutinins key to diagnosis in case of trauma patient
Anemia in man, 37, found to be due to CAD, not blood loss: Study
The detection of cold agglutinins, the self-reactive antibodies that drive cold agglutinin disease (CAD), was crucial for the correct diagnosis and management of anemia — lower than normal levels of red blood cells or hemoglobin — in a 37-year-old man with several traumatic injuries after a motorcycle accident, according to a case study.
The man was experiencing blood loss from the trauma, and emergency department tests showed anemia, or low levels of red blood cells and of hemoglobin, the protein in red blood cells that transports oxygen throughout the body.
The researchers noted that both CAD and trauma-associated bleeding can lead to anemia and its associated symptoms.
“The findings of this case report highlight the importance of recognizing cold agglutinins in trauma patients to avoid misdiagnosis and misinterpretation of laboratory results,” the researchers wrote.
The case study, “Investigating the Impact of Cold Agglutinins on Red Blood Cell Parameters in a Trauma Patient,” was published in the journal Cureus.
Both CAD and blood loss can result in anemia symptoms
CAD is an autoimmune disease triggered by cold agglutinins that bind to red blood cells when the body is exposed to cold temperatures. It causes these cells to clump together and be marked for destruction, or hemolysis.
This results in symptoms of anemia, like fatigue, pallor, and shortness of breath, in addition to other possible manifestations, such as skin discoloration and numbness or tingling of the fingers and toes.
Cold agglutinins can also be produced in response to inflammatory signals from traumatic injuries. In trauma patients, “CAD is typically manifested as [temporary] hemolysis triggered by cold exposure during the traumatic event rather than chronic autoimmune hemolysis,” the researchers wrote.
Given that CAD and blood loss due to traumatic injury can both result in anemia symptoms, “the impact of cold agglutinins on RBC [red blood cell] parameters in trauma patients can … result in misinterpretation of laboratory results, delay in diagnosis, and inappropriate management,” the team wrote.
Now, the team, comprised of researchers in Antigua and the U.S., described the case of a motorcycle accident patient whose anemia was found to be due to cold agglutinins and not blood loss — a correct assessment that helped in his diagnosis and treatment.
The man was admitted to the emergency department following the accident, appearing sleepy or drowsy, and intoxicated, and complaining of breathing difficulties. He acknowledged having consumed several beers before the accident, but denied drug use.
A physical examination found several injuries: a cut on the scalp, broken ribs, and a broken leg. Imaging scans on other body regions were negative for bleeding and fractures.
Cold agglutinins found to cause anemia symptoms after motorcycle accident
Blood testing showed anemia, with low levels of both red blood cells and hemoglobin. The average amount of hemoglobin in a red blood cell and the average size of red blood cells were higher than normal, indicating problems with red blood cells.
A direct Coombs test, which checks whether certain antibodies and/or immune system-related proteins are attached to red blood cells, came back positive, as did a test of IgM, the class of antibodies to which most cold agglutinins belong.
This, combined with red blood cell clumping observed on the microscope and the detection of cold agglutinins, confirmed a diagnosis of CAD for this patient.
“This diagnosis, coupled with the acute blood loss from the motor vehicle accident, likely explains the observed abnormalities in the patient’s RBC parameters,” and “may have contributed to impaired oxygen delivery to tissues, manifesting as difficulty breathing,” the researchers wrote.
“We strongly suspected cold agglutinins as the cause of the deranged RBC parameters due to the combination of acute blood loss and the cold environment in which the accident occurred,” they added.
This case underscores the importance of considering CAD in trauma patients with unexplained anemia and respiratory distress, particularly when there is potential exposure to cold. … Cold agglutinins can complicate the interpretation of lab results and clinical assessments.
The man was treated with intravenous, or into-the-vein, immunoglobulin (IVIG), which was successful in normalizing his blood parameters. IVIG therapy delivers specific antibodies purified from healthy people to neutralize self-reactive antibodies in a patient’s bloodstream and block the abnormal production of those antibodies.
“The patient’s respiratory function improved, anemia symptoms were alleviated, and the patient subsequently underwent management for the polytrauma injuries,” the team wrote.
According to researchers, “this case underscores the importance of considering CAD in trauma patients with unexplained anemia and respiratory distress, particularly when there is potential exposure to cold.” The team noted that “cold agglutinins can complicate the interpretation of lab results and clinical assessments.”
Further, the team wrote that “early intervention with IVIG can both confirm the diagnosis and significantly enhance patient outcomes.”
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