Cold agglutinins

Last updated: Thursday, 01, April, 2004

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Item Process

10 mL blood in plain tube, collected, separated at 37°C, then transported to the laboratory.


Presence of agglutination after incubation of patient’s serum with washed red cells at 4°C, 20°C and 37°C.

Differential testing against cord and adult blood cells may indicate anti-I specificity.


Problems with blood grouping, compatibility testing.

Investigation of positive direct antiglobulin test, possible autoimmune haemolysis.


Cold agglutinins found in (idiopathic) cold haemagglutinin disease, mycoplasma pneumonia (anti-I); some lymphomas (anti-I or anti-i); infectious mononucleosis (anti-i).

Thermal amplitude and specificity is of clinical significance in relation to the risk of in vivo haemolysis.


Dacie JV and Lewis SM. Practical Haematology. 8th ed. Churchill Livingstone 1995.