Cold Antibodies: An uncommon factor in transfusion safety in a tropical country: a report of two cases

Abstract

Background
Cold reacting antibodies with a thermal optimum at 0°C are an uncommon occurrence, and the clinical manifestations are rarely observed in the warm climate of the tropical countries of sub-Saharan Africa.

Objective
The objective of this presentation is to report two cases in which cold-reacting antibodies were detected, and to draw attention to the challenge posed to blood transfusion practice by this occurrence in a tropical developing country.

Method
Two cases are presented of the detection of cold-reacting antibodies at crossmatch. One was a 30 year old pregnant patient with sickle cell anaemia, who was followed up for nine years. The other was a 76 year old patient with colonic carcinoma, who was successfully managed and followed up for three years.

Results
The sickle cell anaemia patient was successfully transfused with warmed blood, but represented nine years later with acrocyanosis and ulcers on the hands and feet. The colonic carcinoma patient was also successfully transfused, and received chemotherapy following surgery. Remission of the malignancy was achieved and thereafter, the cold antibodies disappeared over a follow-up period of three years.

Conclusion
Meticulous crossmatching by standard techniques, of blood for transfusion, and a high index of suspicion and resourcefulness are required to detect and manage anomalous factors in blood transfusion practice in resource-constrained developing countries

Keywords: Cold antibodies, Tropical Nigeria, Transfusion safety