Impact of Severe Cold Agglutination on Routine Red Blood Cell Parameters and Correction Strategies

In blood samples collected from patients with cold agglutinin disease (CAD), red blood cells (RBCs) aggregate due to antigen-antibody reactions mediated by auto-IgM-type cold agglutinins, forming reversible clumps. This phenomenon is relatively common in clinical hematology testing and can significantly interfere with routine parameter measurements by automated hematology analyzers, including red blood cell count (RBC), he-matocrit (HCT), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC). Notably, conventional methods such as 37℃ water baths often fail to correct severely cold-agglutinated specimens.

Cold agglutinated samples were subjected to a 30-minute 37℃ water bath, then immediately analyzed using the closed-whole blood-CDR/PLT-8X mode on a Mindray BC-7500 [NR] CS hematology analyzer to obtain results for the research parameters RBC-O and HF-MCV.

Using the formulas HCT = RBC-O x HF-MCV, MCH = HGB/RBC-O, and MCHC = HGB/HCT, the red blood cell-related parameters such as HCT, RBC, MCV, MCH, and MCHC were calculated.

Severely cold-agglutinated blood samples, when analyzed using the 37℃ water bath combined with the closed-whole blood-CDR/PLT-8X mode, can effectively correct the abnormal results of red blood cells (RBCs) and their related parameters caused by cold agglutinins.