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Transfusion. 2017 Jun;57(6):1480-1484. doi: 10.1111/trf.14059. Epub 2017 Mar 7.

Using direct antiglobulin test results to reduce unnecessary cold agglutinin testing.

Author information

1
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri.
2
Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Abstract

BACKGROUND:

Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia mediated by autoantibodies that preferentially react at 4°C. Laboratory testing for cold-reactive autoantibodies is laborious and may not be ordered judiciously, particularly in patients with a negative direct antiglobulin test (DAT). We sought to determine whether a negative DAT using anti-human complement (anti-C3) rules out elevated cold agglutinin (CA) titers and the diagnosis of CAD.

STUDY DESIGN AND METHODS:

We performed a retrospective study of patients with a CA test performed at three major academic medical centers: Barnes-Jewish Hospital (2003-2014), Vanderbilt University Medical Center (2007-2009), and Massachusetts General Hospital (2009-2014).

RESULTS:

This study included 801 patients, of whom 51% (n = 410) had a DAT within the 7 days before CA testing. A total of 98% of patients with a negative DAT using anti-C3 had a negative CA titer (<64). Only five subjects had a negative DAT using anti-C3 and an elevated CA titer.

CONCLUSIONS:

Overutilization of CA testing could be reduced by establishing laboratory acceptance criteria based on a positive DAT using anti-C3. Such acceptance criteria would have reduced CA testing by 68% for those with an available DAT result.

PMID:
28266038
DOI:
10.1111/trf.14059
[Indexed for MEDLINE]

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