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Unifying serological testing for cold agglutinins
Marit Jalink1,2, Femke V M Mulder1,3, Marianne E George4
1Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.
Vox Sanguinis
|September 10, 2025
Summary
Standardizing cold agglutinin (CA) testing is crucial. This study found that using reheated blood samples simplifies laboratory workflows while maintaining accurate CA titre and thermal amplitude results.
Area of Science:
- Immunology
- Transfusion Medicine
Background:
- Cold agglutinins (CAs) are IgM autoantibodies binding red blood cells at low temperatures.
- Clinical significance relies on CA titre and thermal amplitude, but testing strategies lack standardization.
Purpose of the Study:
- To unify cold agglutinin testing strategies.
- To investigate (pre)analytical variations affecting CA test outcomes.
Main Methods:
- Survey of CA evaluation in 17 Dutch transfusion laboratories.
- Analysis of patient samples to assess preanalytical variations.
Main Results:
- Heterogeneity observed in CA workup indications and preanalytical conditions.
- CA titres were higher with bovine serum albumin (BSA) but consistent between EDTA plasma and serum.
- Reheated EDTA-blood samples yielded results equivalent to continuously warmed samples.
Conclusions:
- Preanalytical conditions significantly impact CA test results.
- Reheated blood samples offer a practical approach for CA testing.
- International standardization of diagnostic CA testing is essential.
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