Reactivity against cord blood, papain and neuraminidase treated red cells were not tested. Serological tests for mycoplasma were negative. Bone marrow biopsy, liver biopsy and computerised tomography of the abdomen did not show evidence of lymphoproliferative disorder. Plasmapheresis failed because of extensive extra-corporeal agglutination, and exchange transfusion did not reduced cold agglutinin titer. The patient finally died of infection.
CHAD can be due to a variety of underlying disorders.
Those with a monoclonal CA, typically IgM k, may be idiopathic or secondary to a lymphoproliferative disorder, while polyclonal CA are reactive to viral or mycoplasma infection. The disease usually runs a benign course, except in cases with a CA of high thermal amplitude that may cause severe hemolysis. The common risk factors were chronic GVHD and prolonged immunosuppression, leading to abnormal immunue reconstitution. In none of these cases was a lymphoproliferative disease demonstrable. A monoclonal paraprotein is often found, reflecting B cell clonal dominance, probably due to an impaired T cell regulation.