[Cold agglutinins of the IgM class in a patient with monoclonal gammopathy of the IgA class]

Abstract

History and clinical presentation: A 61-year-old patient was examined in hospital because he had suffered from fatigue and weight loss for several years. History and physical examination showed no symptoms specific for a disease of a particular organ except a goitre.

Investigations: Laboratory examination serum showed a decreased haptoglobin, a slightly elevated bilirubin, an acceleration of the blood sedimentation rate and a M-gradient in the protein electrophoresis. The immunofixation electrophoresis revealed a monoclonal gammopathy of the IgA-class. The cold agglutinin titre was clearly elevated (2048 at 4 degrees C), caused by an auto-anti-I of the IgM-class. No signs of an infection or a haematological neoplasm were found.

Treatment and course: No specific therapy was given for the compensated haemolytic anaemia and the monoclonal gammopathy. There was no significant change in the course of the disease over 5 years.

Conclusion: Between the specificity and the immunoglobulin class of cold agglutinins correlations exist that are also of significance for these autoantibodies. As shown by this case, an exact analysis of the specificity and the immunoglobulin class of cold agglutinins should be done in cases with unusual combinations of laboratory results to prevent misleading interpretations.