Cold Agglutinins => Autoimmune hemolytic anemia (AIHA) occurring around 28-31°C -> Typically IgM auto antibodies directed against red blood cells, causing clumping (agglutination) of RBCs (i.e Mycoplasma pneumoniae, CMV, EBV, infectious mononucleosis, varicella zoster virus, HIV, lymphoma, CLL, Waldenström’s)
Cryoglobulins => Insoluble immunoglobulins (also IgM/IgG) that precipitate out of serum in cold temperatures and re-dissolve upon rewarming (i.e Hepatitis C, Multiple Myeloma, lymphoma, CLL, sarcoidosis, SLE, RA)
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TYPE 1 CRYOGLOBULINS
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Monoclonal IgM. Think Myeloma/ Lymphoma. Hypervisocity, Raynauds. Digital ischemia
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TYPE 2 CRYOGLOBULINS
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Monoclonal IgM, Poly IgG. Think Infections/ Hepatitis C. Fatigue, Mylagia, Purpura
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TYPE 3 CRYOGLOBULINS
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Poly IgM, Poly IgG. Think autoimmune (i.e Sjogrens).
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TESTS
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ANA, ENA, RF (elevated in 2/3) and C3 and C4 (typically low)
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REFERENCES
- CHAPTER 126: Rheumatology in the ICU. Scott Vogelgesang; Vijay Raveendran Pottathil; John A. Robinson. Principles of Critical Care, 4e
- Chapter 41. Hematologic Emergencies. MK Strecker-McGraw, MD; Wilson Mark Andrew, MD. CURRENT Diagnosis & Treatment Emergency Medicine, 7e