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Cold Agglutinin Titer

Cold Agglutinins

Test Codes

Antrim #30939, EPIC: LAB5826, SOFT: CATR1

Department

Special Chemistry

Specimen Collection Criteria

Collect: One plain Red-top tube.

Specimen Preparation and Transport

Outreach and Outpatient Order:

Beaumont Royal Oak Campus Outpatient Laboratories (MOB, Cancer Center, Imaging Center): Immediately after collection, wrap the specimen in an infant heel warmer and send to the Laboratory for processing.

• Beaumont Patient Service Centers NOT located on the Royal Oak Campus: Immediately after collection, allow the specimen to clot wrapped in an infant heel warmer or in a 37°C dry heating block. Once completely clotted, centrifuge the specimen and immediately transfer serum to a plastic transport tube. Transport to the Royal Oak Laboratory at room temperature.
• Outreach Physician Office/Drawsites: Immediately after collection, the specimen must clot while being maintained at 37°C using warm water, an infant heel warmer, or a heat block. Once completely clotted, centrifuge the specimen and immediately transfer serum to a plastic transport tube. Transport to the Royal Oak Laboratory at room temperature.

Inpatient Orders:

• Royal Oak and Grosse Pointe: After collection, immediately wrap the specimen in an infant heel warmer and transport to the laboratory.
• Troy: After collection, immediately place the specimen in a 37°C dry heating block and transport to the laboratory.

Rejection Criteria

• Specimens refrigerated prior to serum separation.
• Plasma specimens. 
• Severely hemolyzed, lipemic or icteric specimens. 
• Specimens not collected and processed as indicated. 

 

In-Lab Processing

• Specimens from a Beaumont Patient Service Center NOT located on the Royal Oak Campus or a Physician Office/Drawsite: No further processing prior to testing is required. Specimens must be received as a serum aliquot (i.e. separated from cells).
• Specimen from an inpatient or Beaumont Royal Oak Campus Outpatient Laboratory: Maintain the specimen on a warm pack or heat block. After the specimen has clotted, centrifuge the specimen and immediately transfer serum to a plastic aliquot tube.

Storage

Specimen Stability for Testing:

Red-top tube must be maintained at 37°C until clotted, then processed immediately as indicated above.

Serum Specimens (Pour-Overs):

Room temperature (20-26°C or 68-78.8°F): 48 hours
Refrigerated (2-8°C or 36-46°F): 2 weeks
Frozen (-20°C/-4°F or below): 1 year

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days

Laboratory

Royal Oak Special Testing Laboratory

Performed

Monday – Friday.
Results available within 48 hours.

Reference Range

Less than 1:32.

Test Methodology

Hemagglutination.

Interpretation

• Titers of 1:32 or higher are considered elevated. Elevated titers are rarely seen except in primary atypical pneumonia and in certain hemolytic anemias. If the agglutination is not reversible after incubation at 37°C, then the reaction is not due to cold agglutinins.
• In primary atypical pneumonia, cold agglutinins are detected one week after disease onset, they peak 12 to 25 days later, and fall rapidly after day 30. Low titers of cold agglutinins have been demonstrated in malaria, peripheral vascular disease, and some common respiratory diseases.

Clinical Utility

• The cold agglutinin test is used to detect cold agglutinins which are autoantibodies that cause the agglutination of RBC's at temperatures below 37°C (optimally at 4°C). Cold agglutinins can be found in patients with infectious mononucleosis, Mycoplasma pneumoniae infection, chronic parasitic infections, and lymphomas.
• Chronic cold agglutinin disease is a rare condition that presents late in life, usually between 50-70 years old. The disease has an insidious onset with progressive anemia, or it may present acutely following a single episode of cold exposure. Symptoms are caused by hemagglutination and stasis of blood in cold extremities when the ambient temperature is low. Numbing, blue discoloration of the ears, fingers and the tip of the nose occur. Hemolysis appears when circulation is restored on rewarming. Patients with cold agglutinin disease may survive for many years and eventually die from unrelated causes.
• Acute or transient cold agglutinin disease arises in several infectious and inflammatory diseases. The disease is self- limiting and most patients recover fully. However, the severity of the disease is variable and most patients are only mildly anemic and jaundiced. A few patients experience intravascular hemolysis of such severity as to cause renal failure.

CPT Codes

86157
LOINC: 30900-5

Contacts

Last Updated

1/4/2023