Which are the symptoms of Autoimmune Hemolytic Anemia / Cold Agglutinin Disease?

Symptoms of Autoimmune Hemolytic Anemia / Cold Agglutinin Disease

Autoimmune Hemolytic Anemia (AIHA) is a rare condition characterized by the destruction of red blood cells (hemolysis) by the body's own immune system. Cold Agglutinin Disease (CAD) is a specific type of AIHA where the immune system mistakenly attacks red blood cells at low temperatures, typically below body temperature. Both conditions share similar symptoms, which can vary in severity from mild to life-threatening. It is important to note that the symptoms and their intensity can differ from person to person.

1. Fatigue and Weakness

One of the most common symptoms of AIHA/CAD is fatigue and weakness. This occurs due to a reduced number of healthy red blood cells carrying oxygen throughout the body. As a result, individuals may experience a lack of energy, decreased stamina, and overall weakness.

2. Pale Skin and Jaundice

AIHA/CAD can cause pale skin and jaundice (yellowing of the skin and eyes). When red blood cells are destroyed, bilirubin, a yellow pigment, is released. The accumulation of bilirubin in the body leads to jaundice, causing a yellowish discoloration of the skin and eyes. Additionally, the reduced number of red blood cells can result in paleness of the skin.

3. Shortness of Breath and Rapid Heartbeat

Due to the decreased oxygen-carrying capacity of the blood, individuals with AIHA/CAD may experience shortness of breath and a rapid heartbeat. The body compensates for the reduced oxygen supply by increasing the heart rate and respiratory rate. This can lead to feelings of breathlessness, even with minimal physical exertion.

4. Cold Sensitivity and Raynaud's Phenomenon

Cold sensitivity is a hallmark symptom of CAD. Exposure to cold temperatures can trigger the immune system to attack red blood cells, leading to hemolysis. This can cause symptoms such as numbness, tingling, and discoloration of the fingers, toes, nose, and ears. In some cases, individuals may develop Raynaud's phenomenon, where the blood vessels constrict excessively in response to cold, causing further pain and color changes.

5. Enlarged Spleen

In some cases, AIHA/CAD can cause the spleen to enlarge. The spleen plays a role in filtering and removing damaged or old red blood cells from circulation. When there is excessive destruction of red blood cells, the spleen may become enlarged as it works harder to clear the damaged cells. An enlarged spleen can cause discomfort or pain in the left upper abdomen.

6. Dark Urine

AIHA/CAD can lead to the presence of dark-colored urine. The breakdown of red blood cells releases hemoglobin, which can be excreted in the urine. This can cause the urine to appear darker than usual, ranging from brownish to tea-colored.

7. Infections and Increased Susceptibility

Individuals with AIHA/CAD may experience an increased susceptibility to infections. The destruction of red blood cells can compromise the immune system's ability to fight off infections effectively. This can lead to a higher risk of developing infections, such as respiratory tract infections, urinary tract infections, or skin infections.

8. Other Symptoms

In addition to the above symptoms, individuals with AIHA/CAD may also experience:

• Headaches - Due to reduced oxygen supply to the brain.


• Dizziness - Caused by anemia and decreased blood flow to the brain.


• Abdominal Pain - In some cases, AIHA/CAD can cause abdominal discomfort or pain.


• Weight Loss - Unexplained weight loss may occur in some individuals.


• Heart Murmurs - In severe cases, abnormal heart sounds (murmurs) may be detected during a physical examination.

If you suspect you may have AIHA/CAD or are experiencing any of the symptoms mentioned above, it is important to consult a healthcare professional for a proper diagnosis and appropriate management.