Primary chronic cold agglutinin disease (CAD) is an autoimmune haemolytic anaemia in which a specific bone marrow lymphoproliferative disorder causes production of cold agglutinins (CA). Binding of CA to erythrocyte surface antigens results in a predominantly extravascular haemolysis that is entirely complement dependent. Because of complement activation, exacerbations are common during febrile infections, trauma or major surgery. Involvement of the terminal complement pathway with C5-mediated intravascular haemolysis is probably not prominent in stable disease but is supposed to be of importance in exacerbations following acute phase reaction.
We report on a patient with CAD prone to exacerbation of haemolysis during acute phase reactions who was scheduled for cardiac surgery. To prevent her having an exacerbation of haemolysis, we chose to treat her prophylactically with eculizumab along with the usual perioperative precautions. Aortic valve replacement was undertaken with full cardiopulmonary bypass at normothermia. The procedure was successful; no exacerbation of haemolysis was observed, and transfusion requirements did not exceed what could be expected.
- Drug therapy related to surgery
- Haematology (drugs and medicines)
- Haematology (incl blood transfusion)
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Contributors ET planned, wrote the manuscript, provided figure 2 and put everything together. ØAV contributed on the surgical part of case with normal procedure. ØAV collected the data and summarised the report. SB was involved in planning, acquisition and design of figure and reporting and interpretation of data as expert on haemolysis. SB reviewed the paper. GET was also involved in planning, reporting, conception and design of the study. GET was also responsible in acquiring patients and case, and reviewing and interpreting clinical and paraclinical data.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.