Case Report
Published: May 18, 2025 | DOI: 10.24911/ejmcr.9-1917
Cold agglutinin hemolytic anemia in a patient with COVID-19 infection
Authors: Kunal Sharma , Peter Zotor , Lakshmi Kattamuri , Shivangini Duggal , Srija Sirineni , Abhinav Vulisha
Article Info
Authors
Kunal Sharma
Department for Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Peter Zotor
Department for Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Lakshmi Kattamuri
Department for Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Shivangini Duggal
Department for Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Srija Sirineni
Department of Emergency Medicine, Bhaskar Medical College, India
Abhinav Vulisha
Department for Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Publication History
Received: March 17, 2025
Accepted: April 28, 2025
Published: May 18, 2025
Abstract
ABSTRACT
Background: Autoimmune hemolytic anemia (AIHA) is a rare but increasingly recognized complication of COVID-19. We present a unique case of severe cold AIHA (cAIHA) in the setting of concurrent COVID-19 infection that exhibited a relapsing course requiring rescue therapy.
Case Presentation: A 73-year-old male with chronic obstructive pulmonary disease who presented with worsening cough and dyspnea was found to have acute COVID-19 infection. Laboratory investigations revealed severe anemia, elevated lactate dehydrogenase (LDH), low haptoglobin, reticulocytosis, and positive direct antiglobulin test (DAT) with cold agglutinin titers, consistent with cAIHA. Extensive infectious, autoimmune, and malignancy workup was unremarkable. He was initially managed with corticosteroids, folic acid, and weekly rituximab. While symptoms improved temporarily, he experienced hemolytic relapse, necessitating rescue plasmapheresis and transfusion support. Hematologic parameters stabilized, and he was asymptomatic with no evidence of hemolysis at three-month follow-up.
Conclusion: COVID-19 may trigger cold AIHA through immune dysregulation and complement activation. Diagnosing cAIHA in COVID-19 is complex due to overlapping features and high DAT positivity rates without active hemolysis. This case underscores the importance of individualized management, balancing immunosuppression and supportive care. Further research is needed to understand the pathogenesis and optimal treatment strategies for COVID-19-associated cAIHA.
Keywords: hemolytic anemia, COVID-19, cold agglutinins, immune-mediated hemolysis, case report
Pubmed Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. EJMCR. 2025; 18 (May 2025): -. doi:10.24911/ejmcr.9-1917
Web Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. https://ejmcr.com/articles/1917 [Access: May 19, 2025]. doi:10.24911/ejmcr.9-1917
AMA (American Medical Association) Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. EJMCR. 2025; 18 (May 2025): -. doi:10.24911/ejmcr.9-1917
Vancouver/ICMJE Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. EJMCR. (2025), [cited May 19, 2025]; 18 (May 2025): -. doi:10.24911/ejmcr.9-1917
Harvard Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha (2025) Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. EJMCR, 18 (May 2025): -. doi:10.24911/ejmcr.9-1917
Chicago Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. "Cold agglutinin hemolytic anemia in a patient with COVID-19 infection." 18 (2025), -. doi:10.24911/ejmcr.9-1917
MLA (The Modern Language Association) Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha. "Cold agglutinin hemolytic anemia in a patient with COVID-19 infection." 18.May 2025 (2025), -. Print. doi:10.24911/ejmcr.9-1917
APA (American Psychological Association) Style
Kunal Sharma, Peter Zotor, Lakshmi Kattamuri, Shivangini Duggal, Srija Sirineni, Abhinav Vulisha (2025) Cold agglutinin hemolytic anemia in a patient with COVID-19 infection. , 18 (May 2025), -. doi:10.24911/ejmcr.9-1917