Researchers reported the case of a patient with cold agglutinin disease (CAD) who contracted COVID-19 and was treated with veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO), according to a study published in Perfusion. 

The case as presented details a 64-year-old man who presented with increasing dyspnea and cough over the previous week. He had a past medical history of CAD, with cold agglutinins active at room temperature and at 4 °C. 

Upon examination, the patient had an oxygen saturation of 54%. Blood investigations revealed metabolic acidosis (pH 7.20) and anemia (Hb 7.2 g/dL). In addition, the patient had elevated lactate dehydrogenase (2225 IU/L), total bilirubin (3.4 mg/dL), and potassium (>7 mmol/L). His kidney function was normal. 


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Based on these investigations and the patient’s past medical history, his physicians were confident that active hemolysis was the culprit. A direct antiglobulin test revealed the presence of cold agglutinins that were reactive at 4 °C and 37 °C. A COVID-19 test returned positive and his physicians decided that he should be urgently intubated in view of his profound hypoxemia. 

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“As the patient was only 64 years old, living at home in a satisfactory condition, with previous good responses to treatment of his [cold agglutinin hemolytic anemia], reversible cause of respiratory failure, short term mechanical ventilation (only one hour) and availability of sufficient resources, we considered the patient for ECMO therapy,” the authors wrote. 

During the 4-day ECMO run, the patient experienced no major complications, and his body temperature remained stable at around 37 °C. He was successfully weaned off ECMO. Of note, cold agglutinin production persisted after ECMO was discontinued. A month after admission, the patient passed away due to progressive liver failure. 

“It seems that [cold agglutinin haemolytic anaemia] is no contraindication for VV-ECMO, even when both titre and thermal amplitude are high,” the authors concluded. “Although VV-ECMO is feasible in [cold agglutinin hemolytic anemia] patients, the etiology of the [cold agglutinin hemolytic anemia] and response to the therapy will eventually determine the final outcome of those patients.” 

Reference

Raes M, De Becker A, Blanckaert J, et al. Veno-venous extra-corporeal membrane oxygenation in a COVID-19 patient with cold-agglutinin haemolytic anaemia: a case reportPerfusion. 2022;2676591221127932. doi:10.1177/02676591221127932