Severe hemolytic crisis due to cold agglutinins associated with Mycoplasma pneumoniae infection that complicated the compatibility tests

Abstract

The cold agglutinins (CAs) associated with Mycoplasma infection may give rise to autoimmune hemolytic anemia (AIHA), and in rare cases, results in severe crises requiring hospitalization. The present case was this kind with severe hemolytic crises due to clinically significant CA that had caused the life-threatening AIHA in association with the infection by Mycoplasma pneumoniae. The blood specimens were collected in the warm environment to obviate spontaneous autoagglutination. Autoimmune nature of the CA involved was established by the direct antiglobulin test (DAT) using reagents obtained from commercial sources. The serological specificity of the CA was ascertained by titration by saline tube test against the red blood cells (RBCs) from the adults and the newborn infants as well as the hemagglutination inhibition study using human milk as a source of the soluble I antigen. The patient's clinical and other details were obtained from the hospital records. A 20-year-old male admitted to the hospital with a severe hemolytic crisis that required blood transfusion. DAT on his RBCs was positive due to the presence of C3d complement fraction, in concurrence with a high-titer CAs with anti-I specificity and positive serological test for M. pneumoniae. A severe hemolytic crisis was evident by sudden drop in hemoglobin, presence of reticulocytes and erythroblasts in circulation. The patient was conservatively treated with antibiotics, steroid, and blood transfusions with improvement in condition and was discharged after 7 days of hospitalization. He was followed up for the next 3 months through which he continued to be in good condition. The investigations showed a rare case of the CA, with anti-I specificity, causing severe hemolytic crisis in association with M. pneumoniae infection that required hospitalization.