Blood grouping in cold agglutinin disease: A preventable medico-legal predicament

Cold agglutinin disease (CAD) is a rare autoimmune condition characterized by presence of cold-reacting antibodies. This can lead to hemagglutination and complement-mediated hemolysis. Sometimes, it can interfere with serological tests as well. We report a case of CAD where there was a discrepancy in blood grouping initially. The patient presented with complaints of shortness of breath (oxygen saturation of 84% on admission), abdominal swelling , along with evidence of chronic liver disease with cirrhosis. His total and unconjugated bilirubin were raised. Direct antiglobin test was positive. The blood sample showed auto-agglutination at collection, which was grossly visible in the vial. The discrepancy in blood grouping and cross-matching were subsequently resolved. This case points towards the fact that respiratory illness and liver failure can have an underlying association with CAD. A timely diagnosis of CAD and resolving the discrepancies in immuno-hematological tests can avoid many unwanted results and complications, thereby preventing medico-legal issues.