The Correlation of Cold Agglutinin Titrations in Saline and Albumin with Haemolytic Anaemia

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.

[1]  G. Garratty,et al.  The Significance of Red Cell Bound Complement Components in Development of Standards and Quality Assurance for the Anti‐Complement Components of Antiglobulin Sera , 2003, Transfusion.

[2]  C. R. Barker,et al.  The Role of Enzymes and Albumen in Haemagglutination Reactions: A Serological und Ulrrastrucrural Study with Ferritin‐Labelled Anti‐D , 1974 .

[3]  J. Wingham,et al.  Anti‐I Autoantibody Acting Preferentially in Albumin , 1973, British journal of haematology.

[4]  H. Chaplin,et al.  IgG, IgA, and IgM cold-reactive immunoglobulins in 19 patients with elevated cold agglutinins. , 1973, The Journal of laboratory and clinical medicine.

[5]  I. Brodsky,et al.  An IgA High‐Titer Cold Agglutinin with an Unusual Blood Group Specificity within the Pr Complex 1 , 1973, Vox sanguinis.

[6]  S. Ahrons,et al.  IgG Cold Agglutinins and First Trimester Abortion , 1972, Vox sanguinis.

[7]  D. Golde,et al.  Serum agglutinins to commercially prepared albumin. , 1971, American journal of clinical pathology.

[8]  G. Garratty,et al.  An Evaluation of Commercial Antiglobulin Sera with Particular Reference to Their Anticomplement Properties , 1971, Transfusion.

[9]  D. Anstee,et al.  IgG‐Type Cold Agglutinins in Children and Corresponding Antigens , 1971, Vox sanguinis.

[10]  H. Chaplin,et al.  An Enhancing Effect of Albumin on the Determination of Cold Hemagglutinins 1 , 1971, Vox sanguinis.

[11]  P. Gell.  Book Review: Autoimmunization and the Autoimmune Hemolytic Anemias , 1970 .

[12]  J. Dacie,et al.  The Haemolytic Anaemias: Congenital and Acquired , 1968 .

[13]  A. G. Cooper.  Hemagglutinating 7S Subunits of 19S Cold Agglutinins , 1967, Science.

[14]  B. Andersen,et al.  A cold agglutinin of the IgA class. , 1966, Journal of immunology.

[15]  W POLLACK,et al.  A Study of the Forces Involved in the Second Stage of Hemagglutination , 1965, Transfusion.

[16]  D. Roelcke.  Cold agglutination. Antibodies and antigens. , 1974, Clinical immunology and immunopathology.

[17]  J. Cawley,et al.  The role of enzymes and albumen in haemagglutination reactions. A Serological and ultrastructural study with ferritin-labelled anti-D. , 1974, Vox sanguinis.

[18]  H. Schubothe.  The cold hemagglutinin disease. , 1966, Seminars in hematology.