Case Report

Two Cases of Primary Cold Agglutinin Disease Associated with Megaloblastic Anemia

Table 1

Laboratory data of 2 CAD cases.

Case  1Case  2

Age (years)/sex67/M55/M
WBC (3000–8500)/L99006300
Hb (12.5–17.5) g/dL8.14.3
MCV (84.6–100.6) fL 115110
Reticulocytes (0.3–1.1) %11.58.2
PLTs (115,000–305,000)/L198,000147,000
Haptoglobin (19–170) mg/dL672
AST (13–37) IU/L4525
ALT (8–45) IU/L3714
LDH (122–228) IU/L11191021
Total bilirubin (0.3–1.3) mg/dL2.507.94
Direct bilirubin (0.1–0.3) mg/dL1.101.30
Total protein (6.7–8.3) g/dL7.05.9
Albumin (4.1–5.2) g/dL4.04.3
BUN (7.8–18.9) mg/dL19.28.3
Creatinine (0.64–1.11) mg/dL0.880.86
CRP (0–0.29) mg/dL0.600.92
Direct Coombs test*NegativeNegative
Cold agglutinin titer1 : >8,1921 : 16,384
M-proteinPositive (IgM-kappa)Positive (IgM-kappa)
CryoglobulinNegative NT
Soluble IL-2R (122–496) U/mL437NT
IgG/IgA/IgM (820–1740/90–400/31–200)1065/554/217584/NT/164
C3/C4/CH50 (80–140/11–34/30–45)60/5.0/10.856/6.3/7.0
Folate (3.6–12.9) ng/mL10.93.2
Vitamin B12 (233–914) pg/mL85173

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.