Invalidation of antiglobulin tests by a high thermal amplitude cryoglobulin. Transfusion 1990 Feb;30(2):154-7
Date
02/01/1990Pubmed ID
2305443DOI
10.1046/j.1537-2995.1990.30290162903.xScopus ID
2-s2.0-0025062411 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
A multiply transfused patient was referred for evaluation of a transfusion reaction. The direct and indirect antiglobulin tests (DAT, IAT) for alloantibody were negative. However, IgG-coated control cells failed to agglutinate in the negative reactions, casting doubt on their validity. At 4 degrees C, the patient's serum exhibited a large cryoprecipitate (2.9 mg/mL), made up predominantly of an IgG kappa paraprotein and having trace amounts of IgM and C3. Clear serum separated at 37 degrees C became cloudy within 10 minutes at room temperature (RT); within 4 hours, approximately 60 percent of the total precipitable cryoprotein had precipitated. Red cells (RBCs) incubated in fresh serum that had cooled to RT or RBCs obtained from RT or refrigerated samples contained cryoprecipitate that sedimented with the RBCs during washing with RT saline. On resuspension, enough IgG cryoglobulin redissolved to neutralize completely the commercial anti-IgG reagents. If the patient's samples were maintained at 37 degrees C, cryoprecipitate did not form, and RBCs washed four times at 37 degrees C gave valid DAT and IAT reactions. The removal of all cryoprecipitate from the patient's serum by centrifugation after overnight incubation at 4 degrees C also made possible valid antibody screening and compatibility tests.
Author List
Ylagen ES, Curtis BR, Wildgen ME, Mass MD, Chaplin HAuthor
Brian Curtis PhD Director in the Platelet & Neutrophil Immunology Laboratory department at BloodCenter of WisconsinMESH terms used to index this publication - Major topics in bold
Blood Grouping and CrossmatchingBlood Transfusion
Complement C3
Coombs Test
Cryoglobulins
Humans
Immunoglobulin A
Immunoglobulin M
Isoantibodies
Male
Middle Aged
Temperature
