Cold Agglutinin in Dogs

Cold agglutinin is a rare form of autoimmune disease rarely seen in dogs.  Dogs in colder environments have a higher chance of developing this condition than those who live in warmer temperatures.  Diagnosis of this condition will combine lab work with the observed symptoms your dog is experiencing.  There is no exact treatment for this disease; however, your veterinarian can provide supportive treatments and therapies in response to his symptoms.  Even with the treatment your veterinarian can provide, your dog’s prognosis remains fair to guarded.

If your dog has cold agglutinin, it is a life threatening condition that needs to be treated as a medical emergency.  If your dog is experiencing symptoms like weakness, poor pallor, rapid heartbeat and skin ulceration, you need to get him to a veterinarian immediately.

Symptoms of this condition in your dog may include:

• Erythema
• Skin ulceration with secondary skin crusting

Anemia symptoms will include:

•  Weakness
• Pallor
• Icterus (jaundice)
• Tachycardia (rapid heartbeat)
• Tachypnea (rapid breathing)
• Pigmenturia
• Mild splenomegaly (enlargement of the spleen)
• Soft heart murmur

Skin abnormalities in the form of dry, gangrenous necrosis of: 

•  Nose
• Ear tips
• Tail tip
• Feet

Types

Cold agglutinin is a rare form of Type II autoimmune skin disease that is considered a cryopathy, also known as a cold-related hypersensitivity syndrome.  It can occur in any healthy dog of any age, genetic predisposition, breed, and gender.  This condition is more likely to occur in areas with colder climates.  The exposure to the cold is a risk factor to these animals.  This disease involves intravascular erythrocyte agglutination, also known as hemolysis, caused by cold reactive IgM or IgG antibodies.  The erythrocyte autoantibodies react at lower temperatures and produced microvascular thrombosis in your dog’s superficial dermal vessels.

Cold agglutination can be considered an idiopathic primary disease.  This means the cause of this condition is not known and it is not developed as a secondary condition from a different ailment.  If it is diagnosed as a secondary condition, it is typically associated with an upper respiratory infection, lead intoxication, neonatal isoerythrolysis, and neoplasia.

When you arrive at your veterinarian’s office, she will begin by discussing your dog’s symptoms with you.  She will want to know when his symptoms began, if they have been progressing or changing, and if so, how.  She will continue by performing a full physical exam on your dog to evaluate his body system as a whole.  She will note all of his symptoms and begin compiling a list of illnesses she thinks he may be experiencing.

In cases of dogs with cold agglutinin, they usually have an acute onset of the condition follow by a rapid progression of the disease.  The necroses of the skin tissues are characteristic for dog with cold agglutinin.  Your veterinarian may recommend taking a skin sample from the affected areas for pathologic diagnostics.  Pathologic findings typically present results including dermal necrosis and ulceration with opportunistic infections.  It is also common to see evidence of ischemic necrosis from vascular thrombosis.  

Diagnostic lab work will be suggested and consist of multiple tests.  A complete blood count and chemistry panel will be recommended to check for abnormalities within the blood formation process, platelet count and internal organ function.  Also, your veterinarian will check if your dog’s blood cells will clump together (autoagglutination) at room temperature or not.  

A Coombs’ test is a specific test for the presence or absence of immunoglobulins within circulation.  The test needs to be performed at different temperatures for a proper diagnosis.  Results at differing temperatures of 39 degrees Fahrenheit and 99 degrees Fahrenheit can confirm this condition.

The necrosis of your dog’s body tissues is considered progressive.  Your dog will need to be kept in the hospital at a warm temperature until the disease is no longer in the progressive state.  Supportive therapies will be in response to the symptoms your dog is experiencing.  If there is necrosis on the tip of the tail or the feet, your veterinarian may suggest amputation.

When ready to go home, it is imperative you keep your dog in a warm environment at all times to prevent relapse of this condition.  If you live in a cold environment and have to take him outdoors, it is recommended he have a sweater, foot protection, and other items to keep him warm.  As soon as you bring him back inside, it is crucial you ensure his entire body gets back to normal temperature, including the tips of his ears, feet, and tail.

If your dog is suffering from any type of secondary skin issue, it will need to be treated properly.  If your dog is anemic, your veterinarian will treat it is well with medications, therapies, and supplements.  Any other symptoms your dog is experiencing will be treated as your veterinarian sees fit.

The sooner you seek treatment for your dog, the better chance he has at a recovery.  However, even with treatments provided by your veterinarian, some patients do not respond.  This is a very serious condition that can take weeks for your dog to recover from.  Even with proper treatment and care, your dog’s prognosis of recovery is fair to guarded.