Bedrosian C L, Simel D L
South Med J. 1987 Apr;80(4):466-71. doi: 10.1097/00007611-198704000-00015.
Cold hemagglutinin disease is infrequently recognized before complications ensue. We describe a patient with chronic cold hemagglutinin disease who sustained an acute hemolytic crisis during a routine operative procedure in a cool operating room. Cold agglutinins were present during routine preoperative blood cross matching with the Coombs' test positive for C3d. Analysis of the offending cold agglutinin revealed a high-titer monoclonal IgM-kappa antibody with anti-I specificity and broad thermal amplitude. Major complications from the presence of cold agglutinins have been poorly documented and are often thought to be of only theoretic concern. This case and literature review show that such complications may occur and emphasize the importance of careful preoperative plans when the Coombs' test suggests that cold agglutinins exist.
冷凝集素病在并发症出现之前很少被识别。我们描述了一名患有慢性冷凝集素病的患者，他在凉爽的手术室进行常规手术过程中发生了急性溶血危机。在术前常规血型交叉配血时发现有冷凝集素，抗人球蛋白试验C3d呈阳性。对致病冷凝集素的分析显示，这是一种高滴度的单克隆IgM-κ抗体，具有抗I特异性和较宽的热幅度。关于冷凝集素导致的主要并发症的记录很少，人们通常认为其仅具有理论上的意义。该病例及文献综述表明，此类并发症可能会发生，并强调当抗人球蛋白试验提示存在冷凝集素时，术前精心规划的重要性。
