Rare Case of CAD Plus Blood Cancer Found in Man, 56: Report

Researchers note few reported cases of patients with CAD and MDS

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A new case study reports the rare co-occurrence of cold agglutinin disease (CAD) and blood cancer in a man in Iran.

The patient, 56, who had been diagnosed with myelodysplastic syndrome (MDS), an umbrella term for a group of rare blood cancers, was found to also have CAD after experiencing severe anemia.

The study, “Neutrophilic erythrophagocytosis in myelodysplastic syndrome and cold agglutinin disease co-occurrence,” was published in the journal Clinical Case Reports.

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Rare Co-occurrence of CAD and Blood Disorder Reported

Man diagnosed with MDS also found to have CAD

MDS is characterized by the inability of the bone marrow to produce enough healthy blood cells. These include oxygen-transporting red blood cells, immune white blood cells, and platelets, which are tiny blood cells involved in blood clotting.

The disorder frequently co-occurs with autoimmune diseases. However, few reports have described MDS together with CAD, a rare autoimmune disorder in which abnormal antibodies called cold agglutinins attack and destroy red blood cells at low body temperatures.

Another phenomenon rarely associated with MDS is neutrophilic erythrophagocytosis, in which red blood cells are engulfed or “eaten” by a type of immune cell called neutrophils.

Now, researchers at the Kurdistan University of Medical Sciences, in Sanandaj, described this rare phenomenon in a middle-aged man with both MDS and CAD.

The man was treated at the emergency department for severe low red blood cells numbers (anemia) and a low level of consciousness. He had recently been diagnosed with MDS affecting all the blood lineages, but was not yet receiving treatment.

Blood counts confirmed the severe anemia and showed moderately reduced platelet counts.

Further blood tests revealed several alterations in blood cells, including neutrophilic erythrophagocytosis in 2% of neutrophils. Some of the engulfed red blood cells were in an immature state — a phenomenon never previously reported in MDS-CAD, the researchers noted.

Additional lab tests showed alterations in several parameters, including high levels of lactate dehydrogenase and bilirubin, two markers of red blood cell destruction. Levels of ferritin, an inflammation marker, also were elevated. A Coombs test was done to look for cold agglutinin antibodies, which were found at high levels.

Overall, these findings were in line with a CAD diagnosis.

The patient received two units of blood to restore his blood cell levels. The blood units were pre-warmed to prevent further red blood cell destruction due to CAD, and he also was kept in warm conditions.

However, his condition deteriorated and he died 10 hours after the final blood transfusion due to cardiac arrest, in which the heart suddenly stops beating.

“This case has several noteworthy aspects. The first is the coexistence of MDS and CAD, which is rarely reported,” the researchers wrote, They added that the finding of neutrophilic erythrophagocytosis, and particularly of immature red blood cells, also was notable.

“We hope this case aid researchers with better understanding of MDS and CAD co-occurrence,” the team concluded.