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Abnormal Biodistribution on 99mTc-Red Blood Cell–Labeled Multigated Acquisition in the Presence of Suspected Cold Agglutinin Disease

A 99mTc-red blood cell (RBC)–labeled multigated acquisition is a procedure in which the patient’s RBCs are radiolabeled and imaged with electrocardiography-gated cardiac scintigraphy to assess the heart’s pumping efficiency. Cold agglutinin disease, or cold antibody autoimmune hemolytic anemia, is a rare form of autoimmune hemolytic anemia in which the body’s immune system attacks and destroys its own RBCs. This case addresses an altered biodistribution pattern of radiolabeled RBCs in the presence of suspected cold agglutinin disease observed during a multigated acquisition.