Please be aware that all treatments, including blood transfusions, can
have side effects, some known and others yet to be discovered.
Treatments designed to lower the immune system in CAD patients can activate
dormant viruses such as Cytomegalovirus, CMV, a type of herpes, or PML,
Progressive Multifocal Leukoencephalopathy, or others. Also, some treatments
can create an environment for new infections or viruses to arise. Before
embarking on any treatment, we urge you to do as much research as you can on the
web or library and to discuss all pros and cons with your medical professionals.
CAD, no treatment
is usually necessary when the patient's degree of anemia is mild.
are essential as well as a daily dosage of
and avoidance of
exposure to cold.
Black Box Warning
for Procrit, Epogen, and Aranesp
These erythropoietins are sometimes successful in raising hemoglobin levels in
some with CAD but aggressive use of erthropoeisis-stimulating agents to raise
hemoglobin to a target of 11g/dL or greater increases the risk of death, serious
cardiovascular and thromboembolic reactions. If prescribed by your medical
professional, remind him/her of the above warning and ask to use the smallest
possible dose necessary to prevent the need for red blood cell tranfusions.
usually effective in helping warm agglutinins but is an ineffective therapy for
to the use of
rituximab (see below),
immunosuppressive treatments, alkylating agents, and interferon
have been used, with short-lived results and undesirable side effects.
washed red cells are sometimes necessary as a temporary measure when the
hemoglobin gets very low - 7 or lower and the antibody titer is high. The blood
should be warmed to prevent new red cells from being coated with antibodies.
Plasma exchange (plasmapheresis),
which involves filtering blood to remove antibodies, is sometimes helpful when
other treatments fail. This too is a short-lived measure.
is currently the treatment of choice. A round of treatment is normally
four infusions that are given one per week for 4 weeks. Sometimes a second round
of four infusions is prescribed.
There is a risk with
the initial dose due to the possibility
of a serious
allergic reaction. Medical facilities are well aware of this and take special
precautions prior to the infusion.
Rituximab is a single agent monoclonal antibody
designed to kill off the B-cells which make the antibodies that destroy
the red cells. With the destruction of B-cells, the hemoglobin rises.
In time, in most cases, the number of B-cells will again increase and it
may become necessary to retreat with rituximab or another single agent
can have side-effects including fatigue following Rituxan. Please read the
those of you concerned about Rituxan (rituximab) reactions, there's a test
called HAMA (human anti-mouse antibodies) which can determine if patients have
pre-existing human anti-mouse antibodies or developed
them due to recent treatments with mAb (monoclonal antibodies) drugs such as
Rituxan. Discuss with your medical professional.
oral Cytoxan/Sendoxan (cyclophosphamide) and other immunosuppressive
drugs are used in combination for some stubborn cases.
Rituximab plus oral fludarabine
Rituximab plus oral
Fludarabine is another treatment that has yielded promising results in a
recently (2010) completed study by Sigborn Berentsen, M.D., PhD. and et al in
See our Links Page "High Response Rate and Durable
Remissions Following Fludarabine and Rituximab Combination Therapy for Chronic
Cold agglutinin Disease" where you can download this report.
potential side effects which need to be taken into account by your medical
Berentsen has said "As you will read, it is a considerably more aggressive
therapy than Rituximab single agent and, therefore, potentially more toxic; and
we will be cautious in using it in very old and frail patients (e.g., people
over 80-85 suffering from other diseases at the same time)."
In the U.S., the research is being done
through the NIH.
Ulvestad, and Tjonnfjord write that in their experience with CAD patients, even
repeated treatment with rituximab has been well tolerated. (see
page "B-Lymphocytes as targets for Therapy..." 2007).
According to recent published reports, there are several new single agent drugs
like Rituxan which are either in clinical trials or have been approved for use
in Non-Hodgkins Lymphoma, Multiple Myeloma, Chronic Lymphocytic Leukemia,
Rheumatoid Arthritis, Lupus and other autoimmune diseases and may have
application for CAD.
For those with CAD requiring heart surgery or any type of invasive surgery, you
need to be certain to be kept warm and any fluids infused or any necessary
procedures must be performed under warm temperature conditions.
See the links page for a description of a heart bypass on a CADdy.
You need to be aware of the insidiousness of CMV (cytomegalovirus).
It is a dormant virus that can affect those with a weakened immune system.
Our Links page
See our Links for more in-depth information regarding treatments and studies.
Also check the internet.