Felis ISSN 2398-2950

Cold agglutinin disease

Contributor(s): Michael Day

Introduction

  • Uncommon.
  • Cause: intravascular agglutination of erythrocytes and microthrombus formation in peripheral capillary beds.
  • Signs: ischemic necrosis of ear, nose, toes and tail tip.
  • Diagnosis: signs, demonstration of cold agglutination.
  • Treatment: manage underlying problem, symptomatic treatment of lesions.
  • Prognosis: good if damage not too severe and predisposing factors eg cold can be avoided.

Pathogenesis

Etiology

  • Type II hypersensitivity reaction.

Predisposing factors

General

  • Cold temperatures increases agglutination.
  • Freezing weather.
  • Poor husbandry of kittens which become chilled.

Pathophysiology

  • Antibody with complement activation   →   hemolytic anemia and microthrombi formation   →   tissue damage.
  • Primary immune-mediated disease (form of autoimmune hemolytic anemia Anemia: immune-mediated hemolytic) or associated with underlying pathology.
  • Cold reactive IgM autoantibody causes erythrocyte agglutination or hemolysis.
  • Agglutinins bind to erythrocytes and allow complement activation   →   hemolysis   →   anemia.
  • Microthrombi formation in small vessels   →   dry gangrene formation in peripheral tissue   →   necrosis.
    Cold agglutinins optimally active at 0-4 °C but some can interact with erythrocytes at normal body temperatures.

Timecourse

  • Acute onset but predisposition may persist.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bridle K H & Littlewood J D (1998) Tail tip necrosis in two litters of Birman kittens. JSAP 39 (2), 88-89 PubMed.
  • Godfrey D R & Anderson R M (1994) Cold agglutinin disease in a cat. JSAP 35 (5), 267-70 VetMedResource.
  • Zulty J C & Kociba G J (1990) Cold agglutinins in cats with haemobartonellosis. JAVMA 196 (6), 907-910 PubMed.

Other sources of information

  • Day M J (1999) Clinical Immunology of the dog and cat. London: Manson Publishing. ISBN: 1 8745 4598 7.


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