中華民國血液病學會

1. Which statement about diagnosis criteria of cold agglutinin disease is false?

A. Reticulocytosis

B. Hyperbilirubinemia

C. positive Coombs testing

D. Anti-C3 and classically positive anti-IgG

2. Which statement about cold agglutinins disease is false?

A. Cold agglutinin disease is a rare and poorly understood disorder affecting 15% of patients with autoimmune hemolytic anemia.

B. The diagnosis of CAD is established with hemolytic anemia, reticulocytosis, hyperbilirubinemia, elevated lactate dehydrogenase, and positive Coombs testing for anti-C3 and classically negative anti-IgG.

C. All CAD is an immunoglobulin M (IgM) mediated process.

D. Differential diagnosis monoclonal IgM includes disorders such as IgM MGUS, CLL, Myeloma, WM.

3. Which statement is false?
55-year-old male, with asthma and dyslipidemia history but not under regular follow-up or medication control. He visited chest clinic owing to dyspnea on exertion for two to three weeks. Considering his asthma history, inhaler was prescribed at first. However, significant anemia and indirect hyperbilirubinemia were found by laboratory tests. This patient was transferred to hematology clinic for further evaluation. In hematology clinic, further tests were performed, and WM caused cold agglutinin disease (CAD) with autoimmune hemolytic anemia (AIHA) was diagnosed.

A. If patient was not willing to receive injection chemotherapy regimen, rituximab + cyclophosphamide + dexamethasone (DRC) could be considered.

B. In April 2023, there is a more than 90% IgM reduction (from 5340 to 323 mg/dL) of this patient,which means he had achieved complete response (CR) according to NCCN guideline for WM.

C. In older patients, secondary cold agglutinin disease/syndrome may be associated with lymphoid malignancy, like aggressive non-Hodgkin lymphoma or WM.

D. Autoimmune hemolytic anemias (AIHAs) consist of warm-, cold-, or mixed-reactive antibody types that are directed against antigens on the red blood cell (RBC) surface.