{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:16:46Z","timestamp":1789168606067,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,9]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Cold agglutinin syndrome (CAS) secondary to\n Mycoplasma pneumoniae<\/jats:italic>\n typically self\u2010resolves with antimicrobial therapy and supportive care. Therapeutic plasma exchange (TPE) has been described as an adjunct therapy in refractory CAS, but there is limited data on its use in\n M. pneumoniae<\/jats:italic>\n \u2010associated CAS.\n <\/jats:p>\n <\/jats:sec>\n \n Case Presentation<\/jats:title>\n \n A 26\u2010year\u2010old male developed severe hemolytic anemia 3\u2009weeks after initial\n M. pneumoniae<\/jats:italic>\n diagnosis. Initial hemoglobin was 8.2\u2009g\/dL with marked hemolysis (lactate dehydrogenase 1398\u2009U\/L, total bilirubin 4.0\u2009mg\/dL, haptoglobin <10\u2009mg\/dL). Antibody screen was positive for cold antibody. Direct antiglobulin test was C3\u2010positive. Despite appropriate antimicrobial therapy, he required 17\u2009units of packed red blood cells over 20\u2009days of admission.\n <\/jats:p>\n <\/jats:sec>\n \n Intervention and Results<\/jats:title>\n TPE was initiated on day 11 for refractory hemolysis. Four sessions were performed (on days 11, 14, 17, 18). Antibody screens became negative post\u2010TPE and markers of hemolysis improved. Following the final 1.5 plasma volume exchange, the patient achieved his longest transfusion\u2010free interval (5\u2009days). Research flow cytometry demonstrated elevated surface IgG and C3 on red cells pre\u2010exchange that decreased over the course of TPEs but remained above baseline at discharge. The patient required three additional units of red cell transfusions post\u2010discharge but achieved transfusion independence by day 30. Total transfusion requirement was 20\u2009units.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n \n This case of\n M. pneumoniae<\/jats:italic>\n \u2010associated CAS highlights atypical features including failure of antimicrobial therapy and supportive care alone, exceptional transfusion needs, and ongoing hemolysis despite TPE. TPE may serve as adjunctive therapy in transfusion\u2010dependent refractory CAS in the setting of\n M. pneumoniae<\/jats:italic>\n infection.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/trf.70294","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T18:01:22Z","timestamp":1781200882000},"page":"1840-1845","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic plasma exchange for refractory\n Mycoplasma pneumoniae<\/i>\n \u2010associated cold agglutinin syndrome: A case report"],"prefix":"10.1111","volume":"66","author":[{"given":"Alistair","family":"Murray","sequence":"first","affiliation":[{"name":"Division of Hematology, Department of Medicine Western University London Ontario Canada"},{"name":"Department of Pathology and Laboratory Medicine Western University London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-4529","authenticated-orcid":false,"given":"Mischa","family":"Covington","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2991\/chi.k.200706.001"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2033982"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-024-01569-8"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000478991"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2023.e01689"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.smj.0000254212.35432.99"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2024-211535"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22043"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2012.03608.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.3606-24"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-244227"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1977.17277151925.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.70010"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25084296"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.23.3.517-522.1986"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/635670"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.250522"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2019.100648"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021014955"}],"container-title":["Transfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.70294","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/trf.70294","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.70294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:51:54Z","timestamp":1789167114000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/trf.70294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/trf.70294"],"URL":"https:\/\/doi.org\/10.1111\/trf.70294","archive":["Portico"],"relation":{},"ISSN":["0041-1132","1537-2995"],"issn-type":[{"value":"0041-1132","type":"print"},{"value":"1537-2995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"assertion":[{"value":"2025-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}