How I manage cold agglutinins

a rarely cause accelerated destruction of mismatched red blood cells (RBCs), and it is not neces- sary to detect examples of these antibodies that only react below body temperatures. The extent to which cold agglutinins can interfere with the results of pretransfusion antibody detection and compatibility tests is evident from a study by Garratty 1 on the importance of anticomplement reagents in immu- nohematology. With a low-ionic-strength saline (LISS) method that included room temperature incubation and polyspecific (anti-IgG+ C3) antiglobulin serum, the rate of unwanted positive tests (due primarily to the detection of cold-reactive auto- and alloagglutinins) was on the order of 1.41 percent! Omitting the room temperature incuba- tion phase and use of anti-IgG reduced the unwanted pos- itive rate reduced to 0.1 percent.