Cold agglutinin disease coexisting with left main coronary artery involvement and ventricular dysfunction - a challenging triad.

Cold hemagglutinin disease (CHAD) is a rare autoimmune condition characterized by cold-reactive antibodies causing hemagglutination and complement-mediated hemolysis. This case report details the successful management of a 56-year-old male with CHAD, coronary artery disease, and left ventricular dysfunction. The patient underwent coronary artery bypass grafting (CABG) amid challenges, including a rapid drop in hemoglobin levels, limited compatible blood supply, and cardiac comorbidities. Treatment involved rituximab, bortezomib, and a meticulous perioperative protocol to prevent hypothermia. The multidisciplinary approach, including hematologists, anesthetists, and surgeons, played a crucial role in managing the triad highlighting the importance of tailored management in CHAD cases.