All are true about cold agglutinin disease, EXCEPT:

Cold Agglutinin Disease (CAD): Hemolysis is prominent when the body is exposed to the cold. The antibody is usually IgM with an anti-I specificity. Since the antibody is IgM, CAD is related to Waldenstrom macroglobulinemia. Blood transfusion is not effective because donor red cells are I-positive and will be rapidly removed. Rituximab is effective in treatment and Given the long clinical course of CAD, it remains to be seen with what periodicity rituximab will need to be administered. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 882.