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Şimşek E, Karaca OG, Çetinkaya F, Can F, Günaydın S. Incidentally discovered cold hemagglutinins within autologous blood bag and cardioplegia line in a patient with a recent history of COVID-19 undergoing coronary artery surgery. Perfusion 2024; 39:436-438. [PMID: 36475516 PMCID: PMC9732487 DOI: 10.1177/02676591221141323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cold agglutinin disease (CAD) is a rare autoimmune disorder characterized by destruction (hemolysis) of erythrocytes. In CAD, autoantibodies that cause agglutination at temperature of optimum +3-+4 ℃ degree cause symptoms. It is known that CAD often occurs after viral infections. Also, it has been reported in case reports that COVID-19 disease can cause CAD. CASE REPORT 46-year-old male patient with a history of diabetes mellitus and hypertension presented to outpatient clinic in our department to have CABG surgery. He recovered from COVID-19 disease 1.5 months ago. Cardiopulmonary bypass was initiated and the cross-clamp was placed and antegrade Delnido cardioplegia solution was started to be given at +4 ℃. It was observed that the cardioplegia line was agglutinated. On the other hand, it was seen that the autologous blood taken by the anesthesiologist was also agglutinated and formed air bubbles and became unusable. X-clamp was removed and the heart rhythm recovered. The patient was consulted to hematology during postoperative intensive care follow-ups. The cold agglutinin test performed at of +4 ℃ was reported as positive. In this case, we associated the CAD with covid-19 for three main reasons. First one, the patient's complaints about CAD started after COVID-19 disease. Secondly, in the national health archive, the patient's pre-COVID-19 blood tests were completely normal but it was seen that LDH increased and RBC-HCT incompatibility started after COVID-19. As the third, when we search the literature, we have seen the COVID-19 related CAD in many case reports published by hematologists. CONCLUSION With the rare cold agglutinin disease, it seems that we will encounter it more often after the COVID-19 pandemic. Except for deep hypothermia, the most important problem is seen during cardioplegia administration. Therefore, non-blood cardioplegia can be lifesaving.
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Affiliation(s)
- Erdal Şimşek
- Department of Cardiovascular
Surgery, Ankara City Hospital, Ankara, Turkiye
| | - Okay G Karaca
- Department of Cardiovascular
Surgery, Ankara City Hospital, Ankara, Turkiye
| | - Ferit Çetinkaya
- Department of Cardiovascular
Surgery, Ankara City Hospital, Ankara, Turkiye
| | - Ferda Can
- Department of Hematology, Ankara City Hospital, Ankara, Turkiye
| | - Serdar Günaydın
- Department of Cardiovascular
Surgery, Ankara City Hospital, Ankara, Turkiye
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Mehdipour Dalivand M, Woddor N, Makuria A, Aggarwal A, Nava VE. IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction. BMJ Case Rep 2024; 17:e251638. [PMID: 38423573 PMCID: PMC10910471 DOI: 10.1136/bcr-2022-251638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Cold agglutinins produced in the setting of B cell neoplasms, such as lymphoplasmacytic lymphoma and plasma cell myeloma, can mediate autoimmune haemolytic anemia. Transfusion of these patients can exacerbate cold agglutinin-mediated haemolysis. Moreover, the workup for these reactions represents a diagnostic challenge due in part to false negative direct antiglobulin tests (DATs). Here, we report an anaemic patient who after a red blood cell (RBC) transfusion performed without blood warming, experienced a DAT-negative haemolytic transfusion reaction, and was later diagnosed with IgA-multiple myeloma, which showed an uncommon granular pattern by CD138 immunohistochemistry. Extensive workup excluded other diagnostic possibilities, including the presence of Donath-Landsteiner antibodies and cryoglobulins. Successful treatment with CyBorD (cyclophosphamide, bortezomib and dexamethasone) achieved complete remission, and additional RBC transfusions using warmers were completed uneventfully.
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Affiliation(s)
- Maryam Mehdipour Dalivand
- Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Navitha Woddor
- Pathology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Addisalem Makuria
- Department of Pathology, Brody School of Medicine, Greenville, NC, USA
| | - Anita Aggarwal
- Hematology and Oncology, DC VA Medical Center, Washington, District of Columbia, USA
| | - Victor Eduardo Nava
- Department of the Pathology, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA
- Washington DC VA Medical Center, Washington, District of Columbia, USA
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Daryani H, Jamal A, Bhat V, Mukund B. SARS-CoV-2-induced autoimmune hemolytic anemia in pediatric age-group. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Gulati G, Uppal G, Gong J. Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution. Ann Lab Med 2022; 42:515-530. [PMID: 35470271 PMCID: PMC9057813 DOI: 10.3343/alm.2022.42.5.515] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/05/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Automated hematology analyzers generate accurate complete blood counts (CBC) results on nearly all specimens. However, every laboratory encounters, at times, some specimens that yield no or inaccurate result(s) for one or more CBC parameters even when the analyzer is functioning properly and the manufacturer’s instructions are followed to the letter. Inaccurate results, which may adversely affect patient care, are clinically unreliable and require the attention of laboratory professionals. Laboratory professionals must recognize unreliable results, determine the possible cause(s), and be acquainted with the ways to obtain reliable results on such specimens. We present a concise overview of the known causes of unreliable automated CBC results, ways to recognize them, and means commonly utilized to obtain reliable results. Some examples of unreliable automated CBC results are also illustrated. Pertinent analyzer-specific information can be found in the manufacturers’ operating manuals.
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Affiliation(s)
- Gene Gulati
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Guldeep Uppal
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerald Gong
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Balraam KVV, Masood A, Garg N, Somasundaram V. Coomb's negative cold agglutinin disease: A rare report of an incidentally detected case. Asian J Transfus Sci 2021; 15:233-236. [PMID: 34908761 PMCID: PMC8628238 DOI: 10.4103/ajts.ajts_78_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/15/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Abstract
Cold agglutinin disease (CAD) is a rare type of autoimmune hemolytic anemia which usually results due to production of immunoglobulin M-type autoantibody against the I/i and H antigens on red blood cell membrane. They can be idiopathic or may be due to underlying lymphoproliferative disorders or atypical infections. It can have a varied presentation ranging from being incidentally detected to being totally transfusion dependent for a longer or shorter duration. Several factors play a role in determining the ability of cold agglutinins in inducing hemolysis such as antibody concentration and temperature. Here, we present a 54-year-old patient, a known case of chronic obstructive pulmonary disease who was admitted to our hospital in the winter months as a case of alcohol withdrawal syndrome. During the course of the stay, the patient developed respiratory insufficiency and went into Type II respiratory failure and hematological investigations revealed features of CAD.
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Affiliation(s)
- K V Vinu Balraam
- Department of Pathology, Military Hospital, Roorkee, Uttarakhand, India
| | | | - Nidhi Garg
- Department of Lab Medicine, Military Hospital, Roorkee, Uttarakhand, India
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Duffy C, Bain C, Cairo SA, Hogan C, Geldard P, Larobina M, Lin E, Tutungi E, Miles LF. Cold Agglutinin Disease and Hemolytic Crisis After Hypothermic Circulatory Arrest in a Patient With Beta-Thalassemia Minor. J Cardiothorac Vasc Anesth 2020; 34:3086-3092. [PMID: 32245720 DOI: 10.1053/j.jvca.2020.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher Duffy
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Christopher Bain
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Sesto A Cairo
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Christopher Hogan
- Department of Pathology, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Paul Geldard
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Marco Larobina
- Victorian Cardiovascular Services, Richmond, Melbourne, Victoria, Australia
| | - Enjarn Lin
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Elli Tutungi
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia
| | - Lachlan F Miles
- Melbourne Cardiac Anaesthesia, Ivanhoe, Melbourne, Victoria, Australia; Centre for Integrated Critical Care, The University of Melbourne, Parkville, Melbourne, Victoria, Australia.
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Rim JH, Yoo J. Correspondence: Response to "Eliminating or Minimizing the Effects of Cold Agglutinins on the Accuracy of Complete Blood Count Results". Ann Lab Med 2019; 39:501-502. [PMID: 31037872 PMCID: PMC6502943 DOI: 10.3343/alm.2019.39.5.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- John Hoon Rim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea.,Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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