Prednisone, a Steroid, May Treat Primary CAD in Specific Cases

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A 71-year-old woman with primary cold agglutinin disease (CAD) was successfully treated with the glucocorticoid prednisone, a case study reported.

Its scientists noted that primary CAD typically does not respond to glucocorticoids, but in particular instances like this case, it can.

The study, “A Case of Idiopathic Cold Agglutinin Hemolytic Anemia Successfully Treated With Steroids,” was published in the journal Cureus.

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In CAD, autoantibodies known as cold agglutinins bind to red blood cells at low temperatures, causing them to clump together and die in a process called hemolysis.

While in primary CAD the cause of the disease is unknown, secondary CAD is associated with an underlying illness, such as an infection, another autoimmune disorder, or some types of cancer.

Physicians at the Bronxcare Health System in New York described a patient with primary CAD who was successfully treated with prednisone.

The 71-year-old Hispanic woman came to their hospital’s emergency room after experiencing generalized weakness for the past three days. A previous routine blood test showed low levels of hemoglobin, the protein in red blood cells responsible for transporting oxygen in the bloodstream.

She did not report any other serious symptoms, such as chest pain, palpitations, shortness of breath, dizziness, and headache. Her medical history included high blood pressure or hypertension, diabetes, high levels of fatty molecules in the blood (hyperlipidemia), and obstructive sleep apnea. She was being treated for these conditions and had had a colonoscopy — a medical procedure to examine the inside of the large intestine — the previous year that was considered unremarkable.

Blood tests found she had macrocytic anemia, or unusually large red blood cells, and low levels of hemoglobin (mean of 5.1 g/dL; normal range is 11.6 to 15 g/dL). She also a buildup of bilirubin in the blood, which can be triggered by the destruction of red blood cells (hemolysis).

High levels of other hemolysis markers, including lactate dehydrogenase, as well as high reticulocyte, or immature red blood cell, counts were also evident. Tests for CAD-related antibodies also came back positive, but not excessively high.

With no signs of infection, elevated levels of autoautibodies that could signal an autoimmune disorder, or lymphoma or other cancer on chest CT scans, she was diagnosed with primary CAD.

She was treated with the glucocorticoid prednisone at a dose of 40 mg twice daily. After receiving two units of red blood cells, her hemoglobin levels increased.

She was discharged and followed as an outpatient in the clinic. Her prednisone dose has been gradually tapered to 5 mg a day with stable hemoglobin counts.

While “primary CAD is usually resistant to treatment with glucocorticoids,” the researchers wrote, cases have been successfully treated with steroids under a few conditions, including a titer, or concentration, of CAD-related antibodies that is under 1,000.

“Our patient had a titer of 1:610 and responded well to steroids,” the team added.