A Case of Fatal Cold Agglutinin Disease with Malaria

Abstract

The authors report a case of a 55 yr old male who presented with fever, yellowish discoloration of the eyes and altered mental status to the Emergency Department. On examination, pallor, icterus and Splenomegaly were present. Hemoglobin (Hb) was 9.5 gm. % and peripheral smear revealed ring forms of Plasmodium vivax. Serum LDH and Serum bilirubin (Indirect and Direct) were high. This patient's blood group couldn't be found out correctly as there was spontaneous agglutination in all the test and control cells. Indirect Antiglobulin Test (IAT), antibody screening and antibody identification showed pan agglutination. Direct Antiglobulin Test was also positive. The specific but rare problems that can occur due to these pathologic cold agglutinins are to be kept in mind for the accurate diagnosis and early management of these patients