With CAD, your immune system releases an autoantibody, or "cold agglutinin," that attacks healthy red blood cells. Titers of 1:32 or higher are considered elevated by this technique. These red cells can be safely transfused. Defining a reference range for cold agglutinin titers Abstract Background: The cold agglutinin (CAGG) titer is offered at our institution to aid in diagnosing cold agglutinin disease (CAD). Negative (no agglutination) or titer <1:32. Cold agglutinins can cause acrocyanosis and hemolytic anemia. Cold agglutinin disease is a rare form of acquired autoimmune hemolytic anemia in which exposure to cold temperatures can trigger the body's immune system to mistakenly attack and destroy its own red blood cells. It's triggered by cold temperatures, and it can cause problems . Cold Agglutinin Titer, Quantitative. Elevated titers are generally rarely seen except in primary atypical pneumonia due to either M. pneumoniae, influenza A, influenza B, parainfluenza, and adenovirus, and in certain hemolytic anemias. Introduction. Cold agglutinin disease is a rare autoimmune disorder in which autoantibodies produced by a person's immune system mistakenly target and destroy RBCs, causing hemolytic anemia. Cold agglutinins are normally made by the immune system in response to infection. Antibodies are proteins produced by the immune system in response to specific disease agents; autoantibodies are antibodies that the body produces against one of its own substances. Cancer. High titers of cold agglutinins can cause symptoms when a person is exposed to cold temperatures. a titer above 1:32). Primary cold agglutinin disease is distinct from secondary disease, termed cold agglutinin syndrome, which can occur with underlying conditions such as malignancy, infection, and autoimmune diseases.2,3 Diagnosis of cold agglutinin disease is defined by chronic hemolysis, a cold agglutinin titer These natural cold autoantibodies occur at low titers, less than 1:64 measured at 4C, and have no activity at higher temperatures. TEST: 006353 . Pathologic cold agglutinins occur at titers over 1:1000 and react at 28-31C and sometimes at 37C. Corticosteroids are not effective at treating CAD and should not be used as therapy in these patients. Cold agglutinins, or cold autoantibodies, occur naturally in nearly all individuals. Cold agglutinin disease is a rare form of acquired autoimmune hemolytic anemia in which exposure to cold temperatures can trigger the body's immune system to mistakenly attack and destroy its own red blood cells. 5 Clinically relevant titers of cold agglutinins are generally greater than 1:64 and cause typical findings of extravascular hemolysis. Cold agglutinin disease is a rare type of autoimmune hemolytic anemia in which the body's immune system mistakenly attacks and destroys its own red blood cells. 1.0 mL. Hemagglutination (HA) Assay Category. associated with past infections and can cause extravascular hemolysis and is caused by an IgM antibody against antigens on the patient's own RBCs. The cold agglutinin test is not recommended to diagnose Mycoplasma pneumoniae infections. Allow to clot, incubated at 37C, for a minimum of 30 minutes. Presence of agglutination after incubation of patient's serum with washed red cells at 4C, 20C and 37C. Some labs use different measurements or test different samples. Processed Volume: Vomiting or diarrhea. Available for iPhone, iPad, Android, and Web. The test is not a direct measure of clinical significance and must be used in conjunction with other in vitro and in vivo parameters. This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. . Answer. Low titers of cold agglutinins have been demonstrated in malaria, peripheral vascular disease, and common respiratory disease. The complex process leads to hemolysis and eventual anemia.

Cold agglutinin disease (CAD) is a condition that makes your body's immune system attack your red blood cells and destroy them. When affected people's blood is exposed to cold temperatures (32 to 50 F), certain proteins that normally attack bacteria (IgM antibodies) attach themselves to red blood cells and . Hemolytic Cold Agglutinin Syndrome . Minimum volume: 0.5 mL. Chest pains or an irregular heartbeat. 1 CAD accounts for 15% to 30% of autoimmune hemolytic anemias (AIHAs). Our goal was to create a seasonally adjusted reference range using prospective samples and compare it to a reference range generated retrospectively. Cold Agglutinin Titer Blood Test This test measures the level of Cold Agglutinin Autoantibodies in the blood. Cold agglutinin disease (CAD) is a form of autoimmune hemolytic anemia (AIHA), which means the immune system mistakenly attacks and destroys red blood cells. Medical treatment manages cold agglutinin disease. Their appearance is similar to U (Figure 1). Cold agglutinin disease may be primary or secondary, induced by some other disease or condition such as: Mycoplasma pneumoniae infections up to 75% of those affected will have increased cold agglutinins. Normal value ranges may vary slightly among different laboratories. There are two types of the condition, primary and secondary. To diagnose CAD, the following main criteria must be met 1,5: Patients with AIHA and a DAT positive for C3 IgG should be screened for a cold antibody using a direct agglutination test at room temperature (1C) and should be further investigated with an antibody titer in a laboratory performed on a regular basis (2C). Cold agglutinin autoantibodies (CAA) are usually of IgM-class and can be acute or chronic, benign or pathogenic. Critical planning is needed if a patient with a high titer, high thermal amplitude cold agglutinin requires cooling for cardiovascular surgery. Cold agglutinins: no agglutination in titers at or below 1:16; The examples above are common measurements for results of these tests. Cold agglutinin disease (CAD) is a rare type of autoimmune hemolytic anemia which usually results due to production of immunoglobulin M-type autoantibody against the I/i and H antigens on red blood cell membrane. It has not been cleared or approved by FDA. High titres of cold agglutinins may be caused by infections, such as pneumonia caused by mycoplasma, mononucleosis, hepatitis C, or other viral infections. . Cold agglutinins. The high titer of cold agglutinins leads to agglutination of erythrocytes and interferes with their sizing, enumeration and calculation of RDW. ** The cold agglutinin titer was measured at a temperature of 4C. Testing at temperatures higher than 4C is extremely valuable, particularly if the patient is to undergo hypothermia for surgery. Cryoglobulins vs. A 16-yr old boy w/ mono has a cold agglutinin titer of 1:2000. WhatsApp. These antibodies may be found in patients with cold agglutinin disease or may occur transiently following a number of acute infectious illnesses. Cold Agglutinin Titer answers are found in the Davis's Lab & Diagnostic Tests powered by Unbound Medicine. This assay has been validated pursuant to the . A positive titer may mean that the person tested has cold agglutinin disease. Compliance Category The temperature, at which the agglutination (clumping) takes place, varies from patient to patient. Cold agglutinin disease (CAD) has a prevalence of 5 to 20 cases per million and an incidence of 0.5 to 1.9 cases per million per year, showing considerable variation with climate. Irritability or changes in your behavior. If we see cases of CAD with titer <64 that is reactive at 30C with or without albumin, that would be a perfect opportunity to start a conversation with ordering physician with references to Garratty G et al, The correlation of cold agglutinin titrations in saline and albumin with haemolytic anemia, BrJ Haemat 1977;35, along with the paper that . The threshold titer for a diagnosis of CAD is 1:64. Ringing in your ears. The cold agglutinin titer is a diagnostic test for cold agglutinin disease (CAD). LabCorp. However, a fourfold rise in the cold agglutinins usually begins to appear late in the first week or during the second week of the disease and begins to decrease between the fourth and sixth weeks. They cause red blood cells to clump together (agglutinate) at low temperatures. Dear Editor, Cold agglutinin is an autoantibody that causes autoimmune hemolytic anemia by binding to I/i carbohydrate antigens on the red blood cell (RBC) surface [].While RBC agglutination causes clinical symptoms of hemolytic anemia, agglutination caused by cold agglutinin is a notorious pre-analytical and analytical factor that leads to spurious automated complete blood count (CBC) results []. Centrifuge at 37 degrees C and separate serum from red cells immediately after blood clots or within one hour of collection. Aliquot specimen into a 5-mL screw-capped, plastic vial for transport. Distinction from a warm AIHA is important, as therapy differs for the two entities. On the other hand, the pathological agglutinins usually have titers more than 1:512 and react over a wide range of temperature. a. Answer. Normal lab values. The highest dilution at which the cold-induced agglutination of red blood cells takes place is the titer. Cold agglutinins are autoantibodies produced by a person's immune system that mistakenly target red blood cells (RBCs). Test Code CAGG Cold Agglutinin Titer, Blood Important Note. . With the cold agglutinin titer, a titer of 1:64 or greater is considered abnormal when blood is tested at 4C. Hemolysis is mediated by complement fixation on RBC membranes and phagocytosis. On the other hand, in 17th edition of AABB Technical Manual, on page 923 under Method 4-7 Cold Agglutinin Titer Procedure, it says that "Cold-reactive autoantibodies, if present at very high titres, may suggest a pathologic cold agglutinin disease. When your red blood cells are targeted by the cold agglutinins,. Agglutination Titer at 4 C and 37 C. Specimen Requirements. Service Area must be determined. antigens. In this syndrome, cold agglutinins, usually IgM with anti-I specificity, attach to the patient's erythrocytes causing a variety of symptoms. Specimen must be kept at 37 o c until processed by the . Cold Agglutinins => Autoimmune hemolytic anemia (AIHA) occurring around 28-31C -> Typically IgM auto antibodies directed against red blood cells, causing clumping (agglutination) of RBCs (i.e Mycoplasma pneumoniae, CMV, EBV, infectious mononucleosis, varicella zoster virus, HIV, lymphoma, CLL, Waldenstrm . Cold agglutinin disease (CAD) is a form of autoimmune hemolytic anemia (AIHA) in which cold agglutinins (IgM autoantibodies against red blood cell [RBC] antigens with an optimum temperature of 3 to 4C) can cause clinical symptoms related to RBC agglutination in cooler parts of the body and hemolytic anemia.