Two Cases of Primary Cold Agglutinin Disease Associated with Megaloblastic Anemia
Table 1
Laboratory data of 2 CAD cases.
Case 1
Case 2
Age (years)/sex
67/M
55/M
WBC (3000–8500)/L
9900
6300
Hb (12.5–17.5) g/dL
8.1
4.3
MCV (84.6–100.6) fL
115
110
Reticulocytes (0.3–1.1) %
11.5
8.2
PLTs (115,000–305,000)/L
198,000
147,000
Haptoglobin (19–170) mg/dL
67
2
AST (13–37) IU/L
45
25
ALT (8–45) IU/L
37
14
LDH (122–228) IU/L
1119
1021
Total bilirubin (0.3–1.3) mg/dL
2.50
7.94
Direct bilirubin (0.1–0.3) mg/dL
1.10
1.30
Total protein (6.7–8.3) g/dL
7.0
5.9
Albumin (4.1–5.2) g/dL
4.0
4.3
BUN (7.8–18.9) mg/dL
19.2
8.3
Creatinine (0.64–1.11) mg/dL
0.88
0.86
CRP (0–0.29) mg/dL
0.60
0.92
Direct Coombs test*
Negative
Negative
Cold agglutinin titer
1 : >8,192
1 : 16,384
M-protein
Positive (IgM-kappa)
Positive (IgM-kappa)
Cryoglobulin
Negative
NT
HBV/HCV
Negative/negative
Negative/NT
ANA
<×40
<×40
Soluble IL-2R (122–496) U/mL
437
NT
IgG/IgA/IgM (820–1740/90–400/31–200)
1065/554/217
584/NT/164
C3/C4/CH50 (80–140/11–34/30–45)
60/5.0/10.8
56/6.3/7.0
Folate (3.6–12.9) ng/mL
10.9
3.2
Vitamin B12 (233–914) pg/mL
85
173
Anti-IF-Ab
Positive
NT
Anti-PC-Ab
Positive
NT
Employed with wide spectrum antiserum, not with monospecific anti-C3 antibody, WBC: white blood cell counts, PLTs: platelet counts, AST: aspartate aminotransferase, ALT: alanine aminotransferase, LDH: lactate dehydrogenase, BUN: blood urea nitrogen, CRP: C-reactive protein, and ANA: antinuclear antibody; units for IgG, IgA, IgM, C3, and C4 are mg/dL, and unit for CH50 is U/mL; IF: intrinsic factor, PC: parietal cell, Ab: antibody, and NT: not tested.
