Megaloblastic Anemia with Systemic Lupus Erythematosus (SLE)-Induced Cold Agglutinin Syndrome (CAS): A Case Report and Literature Review

Author(s): Bing Li, Xuan Wang, Mengmeng Pan, Xiu Luo, Bing Xiu, Xiuqin Wang, Aibin Liang

Cold agglutinin syndrome (CAS) is an uncommon disease of the blood system, and systemic lupus erythematosus (SLE)-induced cold agglutinin syndrome is also rare. Herein, we report a case of CAS with SLE induced by megaloblastic anemia. The onset of the disease for this patient was severe anemia, but the severity did not match the lack of raw material of the hematopoietic system. Moreover, peripheral blood assay revealed cold agglutinin. The patient was diagnosed with SLE, which was induced by infection and led to CAS. Anti-infection, blood transfusion, and fluid infusion, was administered with warmer S-line to ensure the infusion temperature was maintained at 30°C. Other treatments included an infusion of specially heated red blood cells with appropriate heating and correction of anemia with glucocorticoids, intravenous gamma globulin, cyclosporine, and hydroxychloroquine. Finally, the SLE recovered to the stationary phase. Although megaloblastic anemia is a common disease in the blood system, missed diagnosis is not rare if it is accompanied by other diseases that increase the severity of anemia. Thus, the primary cause of anemia should be explored and use targeted treatment employed.