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I have kept a meticulous journal since I learned that I have cold agglutinin disease (CAD). There have been many twists and turns and relying on memory hasn’t worked as there are just too many things that come up. Due to this, I use a journal so I can recognize recurring patterns. One of which has been dehydration.

I have been complaining for some time of stomach issues and from what I can tell these stem from chronic dehydration. I learned recently that dehydration is associated with anemia and CAD is a subset of autoimmune hemolytic anemia. This is another symptom on a long list of symptoms that I wish I was aware of earlier.

As is well known, keeping your body well hydrated is vital to our overall health in order to keep the body functioning properly. I read a study that said, “a steady intake of water can help with anemia.” This is interesting because I never made that connection. This is just not something we think about in our daily lives but it makes sense that water helps your blood to flow freely through your veins. 


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As of late, it has been a warm early spring, but I still have been struggling. My last hemoglobin (HGB) test was 10.2, which means I should feel normal. I have begun to think about what is different, and the only factor that stands out is, once again, being dehydrated.

It is true that my kidneys, spleen, and other organs need to work harder to flush out toxins caused by dead red blood cells, so perhaps it spells a greater need to increase water intake. Oddly, the symptoms of dehydration are in line with some of my typical CAD symptoms when I have had a low HGB.

As I said earlier, I have just felt off and unwell for the past few days. The symptoms were heart palpitations, a general feeling of weakness, and swishing in my ears. These are all symptoms of low HGB that I have experienced in the past. To remedy this, I usually lay down for a bit and I regain the energy from the lack of oxygenated red blood cells and then all is well. However, this time it took longer and would only give me back shortened spurts of energy; I am on my second day of this. 

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Luckily yesterday, I realized how parched I was, drank some electrolytes, and slowly over time I started to feel better and by the evening I was fine. However, today the same chain of events began. 

I have discussed previously that I number my water bottles to keep track and I make every effort to drink 3 liters daily, the recommendation for an adult female. This is a lot of water and I feel waterlogged by the time the day is done. I often get overheated at night and sweat, which is near impossible to keep regulated and for this reason, I overcompensate my fluid intake. Yet, I am always thirsty, even though I drink a lot. I should feel completely fine but then I realized the excessive sweating when sleeping is making me lose a great deal of fluid. 

Obviously, dehydration is dangerous for anyone, especially if it is extreme. However, for people with conditions like CAD, it has an added level of urgency. It is essential to make sure that you are aware of how much water you are drinking.

As I read more about dehydration, I learned that it could cause dehydration anemia, which is a condition that makes your red blood cells stick together. This finding is a red flag for me. It adds a whole other level of concern for CAD patients as to when we experience an activation of cold agglutinins that make our blood clump together. And that makes our hearts work harder to pump this thickened blood through our systems. Having both at the same time would be catastrophic. It is as vital for us to stay hydrated as it is for us to avoid the cold.