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The Correlation of Cold Agglutinin Titrations in Saline and Albumin with Haemolytic Anaemia
Author(s) -
Garratty George,
Petz Lawrence D.,
Hoops J. K.
Publication year - 1977
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1977.tb00623.x
Subject(s) - cold agglutinin , agglutinin , albumin , cold agglutinin disease , titer , medicine , serology , coombs test , chemistry , serum albumin , saline , immunology , antibody , lectin , autoantibody
Cold agglutinin syndrome (CAS) is usually associated with IgM cold agglutinins with titres exceeding 1000 at 4deg;C and a thermal amplitude of 30‐32deg;C. Occasionally patients are encountered who although having clinical and laboratory findings compatible with CAS do not have the characteristic serological findings. Thirty‐two patients with a positive direct antiglobulin test due to complement sensitization were studied. Thirty‐one of these patients had cold agglutinin titres greater than 64. Twenty‐eight had haemolytic anaemia, including one patient with a cold agglutinin titre of only 8 against saline‐suspended red cells. 53.6% of sera from patients with haemolytic anaemia reacted at 30deg;C and 7.1% at 37deg;C when albumin was not present, whereas in the presence of albumin all of the sera reacted at 30deg;C and 67.9% reacted at 37deg;C. None of the four patients without haemolytic anaemia reacted at 30deg;C or 37deg;C in the presence of albumin, even though one serum reacted to a titre of 1280 at 4deg;C. Cold agglutinin titres and thermal amplitudes in the presence of bovine albumin were found to correlate better with haemolytic anaemia than reactions without albumin. If bovine albumin is utilized in compatibility testing, multiple cold autoabsorptions may be necessary before alloantibody activity at 37deg;C can be excluded.