A case report: cold hemagglutinin disease in a pancreatic and renal transplant patient

A 33-year-old white male, 30 days postpancreatic transplant, with a history of juvenile onset diabetes mellitus and previous renal transplant, appeared to have cold hemagglutinin disease (CHD). He was being treated for acute organ rejection and had received two units of red blood cells (RBCs) on postoperative day 11, at which time no serum antibodies were detectable. On postoperative day 30, serum studies showed an autoanti-I with a titer of 512 in 30 percent albumin at 4°C and a maximum thermal amplitude of 37°C. The patient had a weakly positive direct antiglobulin test (DAT) with only complement detectable on the red cells. The patient recovered spontaneously. The etiology of the CHD is unclear. The use of cyclosporin-A, OKT3 monoclonal anti-body, and anti-thymocyte globulin (ATG) to treat acute rejection could have played a part.