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Cold Agglutinin Disease(CAD) is a rare autoimmune haemolytic anaemia in which antibodies, usually immunoglobulin M (IgM), bind to red blood cells at cooler temperatures. This triggers complement activation and causes premature destruction of red blood cells, leading to haemolytic anaemia. CAD may occur as a primary disorder or develop secondary to infections, autoimmune conditions, or certain lymphoproliferative diseases.

Common symptoms include fatigue, weakness, dizziness, shortness of breath, pale skin, and rapid heartbeat caused by anaemia. Some individuals develop cold-related circulatory symptoms such as bluish or painful fingers, toes, ears, or nose. Symptoms may worsen during exposure to cold environments.

Diagnosis involves a complete blood count, evidence of haemolysis, direct antiglobulin testing, and detection of cold agglutinins. Blood samples may require careful warming during laboratory testing to obtain accurate results.

Treatment depends on disease severity and the underlying cause. Avoiding cold exposure can help reduce symptoms. Supportive care may include folic acid and blood transfusions when clinically necessary. Rituximab-based therapy and complement-directed treatments may be considered for significant or persistent disease. Managing an associated infection or underlying lymphoid disorder is also important.

With appropriate monitoring and treatment, many patients can achieve improved haemoglobin levels and reduced haemolytic activity.