Bloody Minded Episode 19 - In The Lab: Advanced Haemolysis Testing
Oct 1, 2024
Join the hosts as they dive deep into the intriguing world of advanced haemolysis testing! Discover the complexities of cold agglutinin disease and its impact on lab results. Learn about the nuances of mean corpuscular hemoglobin concentration and how it relates to cold agglutination. Explore cutting-edge methodologies for diagnosing conditions like paroxysmal cold hemoglobinuria and hereditary spherocytosis. Plus, gain insights into the genetics of unstable hemoglobins and the innovative techniques used for their analysis!
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High MCHC Indicates Cold Agglutinins
- A high MCHC with high MCV on a full blood count can hint at cold agglutinin disease due to red cell microaggregates at room temperature.
- The analyzer falsely elevates MCHC because it sees normal hemoglobin in a spuriously lower red cell volume from clumping.
Warm Samples for Accurate Cold Agglutinin Tests
- When cold agglutinin is suspected, reprocess the blood film after warming the sample to 376C to partially resolve agglutination.
- Ensure samples for cold agglutinin testing are collected and kept warm at 376C from bedside to lab to prevent false results.
Understanding Cold Agglutinin Titers
- Cold agglutinin titer above 1:64 is usually clinically significant but lower titers can be seen in healthy individuals.
- Testing serum against red cells with big I or little I phenotypes determines antibody specificity; big I is common, little I is rare.