Unifying serological testing for cold agglutinins

Vox Sanguinis, vol. 120, pp. 944–949

Abstract

BACKGROUND AND OBJECTIVES: Cold agglutinins (CAs) are immunoglobulin M autoantibodies that optimally bind to red blood cells at low temperatures. The clinical significance of CAs is usually characterized by the CA titre and thermal amplitude. However, there is no consensus on the optimal testing strategy. In this study, we sought to unify CA testing. MATERIALS AND METHODS: A survey on CA evaluation was conducted in 17 Dutch transfusion laboratories. Additionally, samples from 16 patients with CAs were used to evaluate (pre)analytical variations in test outcomes. RESULTS: The survey on CA evaluation revealed heterogeneity in the indications for CA workup and in (pre)analytical conditions. Titration results between EDTA plasma and serum did not differ. However, titres were higher when 2% bovine serum albumin (BSA) was present in the titration medium. Routinely collected EDTA-blood kept at 37°C for 10 min before plasma isolation (reheated) showed equivalent results to plasma from blood kept at 37°C from collection through separation. CONCLUSION: This study showed that different (pre)analytical conditions influence test outcomes in the characterization of CAs. Importantly, CA testing can effectively be performed with reheated blood samples, which will facilitate a more practical workflow for laboratories. International standardization of CA testing for diagnostic use is essential.

Authors 6

1. Marit Jalink corresponding Aachen Department of Hematology Leiden University Medical Center Leiden The Netherlands Department of Hematology, Leiden University Medical Center

   Leiden University Medical Center · Sanquin

   Affiliation as printed

   Department of Hematology Leiden University Medical Center Leiden The Netherlands

   Sanquin Research Amsterdam The Netherlands

   Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

   Sanquin Research, Amsterdam, The Netherlands

2. Femke V. M. Mulder Aachen Department of Hematology Leiden University Medical Center Leiden The Netherlands Department of Hematology, Leiden University Medical Center

   Leiden University Medical Center · Sanquin · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Hematology Leiden University Medical Center Leiden The Netherlands

   Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam Amsterdam The Netherlands

   Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

   Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

3. M George

   Sanquin

   Affiliation as printed

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam The Netherlands

   Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands

4. Josephine M. I. Vos

   Sanquin · Amsterdam University Medical Centers · Cancer Center Amsterdam

   Affiliation as printed

   Department of Hematology Amsterdam University Medical Center, Cancer Center Amsterdam Amsterdam The Netherlands

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam The Netherlands

   Lymphoma and Myeloma Center Amsterdam (LYMMCARE) Amsterdam The Netherlands

   Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands

   Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands

5. Masja de Haas Aachen Department of Hematology Leiden University Medical Center Leiden The Netherlands Department of Hematology, Leiden University Medical Center

   Leiden University Medical Center · Sanquin

   Affiliation as printed

   Department of Hematology Leiden University Medical Center Leiden The Netherlands

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam The Netherlands

   Department of Medical Affairs Sanquin Blood Supply Amsterdam The Netherlands

   Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

   Department of Medical Affairs, Sanquin Blood Supply, Amsterdam, The Netherlands

6. Claudia C. Folman

   Sanquin

   Affiliation as printed

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam The Netherlands

   Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands