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Lab Test: Cold Agglutinin Titer Level

    Lab Test
    • Cold Agglutinin Titer
    • Detects antibodies that agglutinate red blood cells in cold temperatures
    Reference Range
    • Titers less than 1:32 are nondiagnostic* (PDR)
    • Screen:  negative
    • Titer:  no agglutination ≤ 1:64
    Indications & Uses
    • Cold autoimmune hemolytic anemia:
      • Markedly elevated, usually in the range of 1:1,024 to 1:512,000. 
      • Titer decreases after treatment. 
    • Suspected Mycoplasma pneumoniae pneumonia:
      • An initial titer of 1:128, or a four-fold increase between the acute and convalescent sera, suggests mycoplasma pneumonia. 
      • A negative titer does not necessarily exclude the diagnosis.
    Clinical Application
    • Cold agglutinins are antibodies (usually IgM) to erythrocytes.  All individuals have circulating antibodies directed against red blood cells, but their concentrations are often too low to trigger disease or symptoms (titers < 1:64).  In individuals with cold agglutinin syndrome, these antibodies are much higher (> 1:512).  At body temperatures of 28-31°C, these antibodies can cause a variety of symptoms (from chronic anemia caused by intravascular hemolysis or extravascular sequestration of affected RBCs leading to acrocyanosis of the ears, fingers, or toes because of local blood stasis in the skin capillaries). 
    • Hemolysis occurs in association with very high cold agglutinin titers (greater than 1:500). 
    • Increased levels may indicate:
      • Mycoplasma pneumoniae infection, viral illness, infectious mononucleosis, multiple myeloma, scleroderma, cirrhosis, staphylococcemia, thymic tumor, influenza, rheumatoid arthritis, lymphoma, systemic lupus erythematosus, or primary cold agglutinin disease.
    Related Tests
    • Mycoplasma pneumonia Antibodies - the serologic identification of IgG and IgM antibodies to Mycoplasma are used to support the clinical diagnosis of the infection.
    Drug-Lab Interactions
    • Results increased in blood dyscrasias, liver disease, or collagen vascular diseases
    • Some antibiotics (penicillin and cephalosporins) can interfere with the development of cold agglutinins.
    Test Tube Needed
    • Lavender or blue top tube* (PDR)
    • Red top tube
    • Collect a venous sample
    • Apply pressure to the venipuncture site.
    Storage and Handling
    • Transport the specimen immediately to the laboratory. 
    • Keep sample at 37°C8 (PDR)
    • Under no circumstances should be cold agglutinin specimen be refrigerated.  (Mosby's)
    What To Tell Patient Before & After
    • Explain the procedure to the patient.
    • Tell the patient that no fasting is required.
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.
    • Pagana K, Pagana TJ eds. Mosby's Manual of Diagnostic and Laboratory Tests. 5th Ed.  St. Louis, Missouri. 2014.

MESH Terms & Keywords

  • Cold, Agglutinin, Titer