Title : Covid-19-induced cold agglutinin disease
Abstract:
Introduction:Coronavirus disease 2019 also known as COVID-19 is caused by SARS-CoV-2 virus. The disease's symptoms range from asymptomatic to inflammatory cytokine form involving multiple organs. Hematological complications of COVID-19 include cytopenia, coagulation abnormalities, thrombosis, and embolic events. Cold agglutinin is antibodies to the red blood cells antigen that leads to hemolysis via complement fixation when the temperature drops below normal physiological temperature. We report a case of COVID-19-induced cold agglutinin disease in a patient.
Methods: A 96-year-old female with a past medical history of coronary artery disease with multiple stents, hypertension, and chronic back pain presented to the emergency department with a chief complaint of shortness of breath for a day. She tested positive for Covid-19 infection via rapid test at home and was diagnosed with COVID-19 after getting a PCR in the hospital. She was given steroids in the emergency department and oxygen supplementation via nasal cannula. Her hemoglobin became low during her hospital stay. Her peripheral blood smear showed cold agglutinin. One unit of warm blood was transfused and her hemoglobin improved post-transfusion. After excluding all the causes of cold agglutinin disease, she was diagnosed with COVID-induced cold agglutinin disease.
Results: Cold agglutinin syndrome (CAS) occurs due to an autoimmune disorder, or infection such as mycoplasma, EBV, or lymphoid malignancy. Our patient did not have any risk factors for cold agglutinin disease except for a COVID-19 infection.
Lymphoid malignancies have immunoglobulin that is monoclonal while polyclonal immunoglobulin is prominent during infection. Our patient had polyclonal immunoglobulins. Glucocorticoids such as dexamethasone are used to decrease mortality in COVID-19 patients on respiratory support. However, glucocorticoids are not effective in cold agglutinin syndrome.
Audience Takeaway:
COVID-19-induced cold agglutinin syndrome is fairly uncommon. However, physicians should be aware of the disease-related complications and any sudden decrease in the hemoglobin levels in patients with Covid 19 should warrant checking for cold agglutinin syndrome. Various treatment modalities for this complication should be explored as such a complication can increase the morbidity and mortality associated with the disease. Association between COVID-19 and cold agglutinin syndrome is a novel finding and warrants further research in this field.
