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Beaumont Laboratory

Cold Agglutinin Titer

Cold Agglutinins, Antrim #30939, EPIC: LAB5826, SOFT: CATR1

Specimen Collection Criteria

Collect: One plain Red-top tube.

Specimen Preparation and Transport

Outreach and Outpatient Orders:

  • 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.
  • 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.

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 or lipemic specimens.
  • Specimens not collected an processed as indicated.


Specimen Stability for Testing:

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

Specimen Storage in Department Prior to Disposal:

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


Royal Oak Special Testing Laboratory.


Monday - Friday.
Results available within 48 hours.

Reference Range

Less than 1:32.

Test Methodology



  • 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 M. pneumoniae infections, a four-fold increase in antibody titer is found in 55 to 65% of patients. 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 are found in patients with infectious mononucleosis, Mycoplasma pneumoniae infection, chronic parasitic infections, or 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, blueing 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 infective and inflammatory diseases. M. pneumoniae is the most common cause. 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 Code


Test Codes

Antrim #30939, EPIC: LAB5826, SOFT: CATR1

Last Updated


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This directory currently reflects information only for specimens collected and/or processed at the Farmington Hills, Grosse Pointe, Royal Oak, and Troy campuses.