# A Rare Case of Severe Cold Autoimmune Hemolytic Anemia in a Hemochromatosis Carrier

## TL;DR

This paper reports a rare case of a patient with hemochromatosis and cold autoimmune hemolytic anemia, highlighting the challenges of managing overlapping rare conditions.

## Contribution

The novelty lies in documenting a rare co-occurrence of cAIHA and hemochromatosis with acute decompensated cirrhosis.

## Key findings

- The patient had severe cAIHA with hemoglobin levels under 8 g/dL and complications like hepatosplenomegaly and hypotension.
- Heterozygous hemochromatosis, typically asymptomatic, appeared to worsen the patient's liver dysfunction when combined with cAIHA.
- Managing overlapping rare hematological and metabolic conditions presented significant clinical challenges.

## Abstract

Cold autoimmune hemolytic anemia (cAIHA) is a rare form of anemia characterized by antibody‐mediated red blood cell destruction at low temperatures (i.e., below 98.6°F or 37°C). Patients with severe cAIHA exhibit hemoglobin levels under 8 g/dL. Affected patients present with hepatosplenomegaly, hypotension, tachycardia, and an increased risk of death with a 5‐year survival rate of 63.5%. Treatment with immunosuppressants and lifestyle modifications can improve cAIHA symptoms. However, the presence of a concurrent disease process can worsen clinical outcomes. In our report, we discuss the clinical management of acute decompensated cirrhosis secondary to heterozygous hemochromatosis complicated by cAIHA. Hemochromatosis is characterized by increased iron deposition that results in organ dysfunction. On admission, the patient presented with anemia, weight loss, and ascites. Although heterozygous hemochromatosis is typically asymptomatic, the presence of cAIHA appears to have contributed to the patient’s liver dysfunction. Requiring different treatment regimens, the case underscores the difficulty of managing multiple rare hematological conditions.