Ikram Jibran, Jackson Chase, Ayad Sabry
Department of Outcomes Research, Anesthesiology Institute Cleveland Clinic Cleveland Ohio USA.
Clin Case Rep. 2024 Nov 29;12(12):e9645. doi: 10.1002/ccr3.9645. eCollection 2024 Dec.
Cold agglutinin disease (CAD), a rare autoimmune hemolytic anemia (AIHA), is characterized by hemolysis triggered by activation of the classical complement pathway. AIHA is estimated to affect one in 100,000 people in the general population; however, its incidence in pregnant women is unclear due to the scarcity of published studies. Here, we present the case of a 37-year-old female (G2P1102) who presented for a repeat Cesarean section. Her peripartum course was complicated by anemia (hemoglobin 7.9 g/dL, hematocrit 29.4%) attributed to cold agglutinin disease, necessitating the transfusion of 20 units of blood during this pregnancy. She had been receiving prednisone 10 mg daily for anemia. Cold temperatures can trigger the activation of cold-reactive antibodies, leading to red blood cells agglutination (clumping together). Preventing hypothermia reduces the likelihood of cold-induced hemolysis, which is the primary therapeutic strategy for cold agglutinin disease. Anesthetic management for the cesarean section was accomplished via spinal anesthesia, complemented by pain control through bilateral transversus abdominis plane (TAP) blocks. This multidisciplinary approach facilitated effective pain management while considering the patient's underlying condition.
冷凝集素病（CAD）是一种罕见的自身免疫性溶血性贫血（AIHA），其特征是由经典补体途径激活引发溶血。据估计，AIHA在普通人群中的发病率为十万分之一；然而，由于已发表的研究较少，其在孕妇中的发病率尚不清楚。在此，我们报告一例37岁女性（G2P1102）因再次剖宫产就诊的病例。她的围产期过程因冷凝集素病导致的贫血（血红蛋白7.9g/dL，血细胞比容29.4%）而复杂化，在此期间怀孕需要输注20单位血液。她因贫血每天接受10mg泼尼松治疗。低温可触发冷反应性抗体的激活，导致红细胞凝集（聚集在一起）。预防体温过低可降低冷诱导溶血的可能性，这是冷凝集素病的主要治疗策略。剖宫产的麻醉管理通过脊髓麻醉完成，并辅以双侧腹横肌平面（TAP）阻滞进行疼痛控制。这种多学科方法在考虑患者基础疾病的同时促进了有效的疼痛管理。
