Red cell agglutination

Short description: Clumping of red blood cells

This page is about the hematologic condition. For the use of red cell agglutination as a testing method, see hemagglutination.

Red cell agglutination in a patient with cold agglutinin disease.

In hematology, red cell agglutination or autoagglutination is a phenomenon in which red blood cells clump together, forming aggregates. It is caused by the surface of the red cells being coated with antibodies.[1]: 98 This often occurs in cold agglutinin disease, a type of autoimmune hemolytic anemia in which people produce antibodies (termed cold agglutinins) that bind to their red blood cells at cold temperatures and destroy them. People may develop cold agglutinins from lymphoproliferative disorders, from infection with Mycoplasma pneumoniae or Epstein–Barr virus, or idiopathically (without any apparent cause). Red cell agglutination can also occur in paroxysmal nocturnal hemoglobinuria[2]: 13 [3] and warm autoimmune hemolytic anemia.[4]: 88 In cases of red cell agglutination, the direct antiglobulin test can be used to demonstrate the presence of antibodies bound to the red cells.[3]

## Contents

* 1 Interference with laboratory tests
* 2 References

## Interference with laboratory tests

Red blood cell aggregates are counted as single cells by the automated analyzers used to run complete blood count tests. This leads to a markedly decreased red blood cell count and hematocrit and markedly elevated mean cell volume and mean cell hemoglobin concentration.[5]: 32–3 Red cell agglutination also interferes with routine methods for blood typing and blood compatibility testing, which rely on agglutination reactions. People with red cell agglutination may exhibit spontaneous agglutination reactions during testing, leading to a false positive result.[6]: 141, 262 If the causative antibodies are only active at room temperature, the agglutination can be reversed by heating the blood sample to 37 °C (99 °F). People with warm autoimmune hemolytic anemia may exhibit red cell agglutination that does not resolve on warming.[4]: 88

## References

1. ↑ Bain, BJ (20 January 2015). Blood Cells: A Practical Guide (5 ed.). John Wiley & Sons. ISBN 978-1-118-81733-9. https://books.google.com/books?id=dckoCQAAQBAJ.
2. ↑ Hematology and Clinical Microscopy Committee (2019). "Blood cell identification". Hematology and Clinical Microscopy Glossary. College of American Pathologists. Archived from the original on 2019-06-28. https://web.archive.org/web/20190628144822/https://documents.cap.org/documents/2019-hematology-clinical-microscopy-glossary.pdf. Retrieved 2020-06-25.
3. ↑ 3.0 3.1 Quist, Erin; Koepsell, Scott (2015). "Autoimmune Hemolytic Anemia and Red Blood Cell Autoantibodies". Archives of Pathology & Laboratory Medicine 139 (11): 1455–8. doi:10.5858/arpa.2014-0337-RS. PMID 26516943.
4. ↑ 4.0 4.1 Kottke-Marchant, K; Davis, B (6 June 2012). Laboratory Hematology Practice. John Wiley & Sons. ISBN 978-1-4443-9857-1. https://books.google.com/books?id=dlZDhbXDuOQC.
5. ↑ Bain, BJ; Bates, I; Laffan, MA (2017). Dacie and Lewis Practical Haematology (12 ed.). Elsevier Health Sciences. ISBN 978-0-7020-6925-3. https://books.google.com/books?id=rEPUDAAAQBAJ.
6. ↑ Denise M Harmening (30 November 2018). Modern Blood Banking & Transfusion Practices. F.A. Davis. ISBN 978-0-8036-9462-0. https://books.google.com/books?id=vxyDDwAAQBAJ.

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Abnormal clinical and laboratory findings for blood tests (R70–R79, 790)

Red blood cells|

| Size|

* Anisocytosis
* Macrocyte
* Microcyte

|

Shape|

* Poikilocytosis
* membrane abnormalities:
* Acanthocyte
* Codocyte
* Ovalocyte
* Spherocyte
* Dacrocyte
* Echinocyte
* Schistocyte
* Degmacyte
* Drepanocyte
* Stomatocyte
* Knizocyte

Hemoglobinization|

* Anisochromia
* Hypochromia

Inclusion bodies|

* Developmental
* Howell–Jolly body
* Basophilic stippling
* Pappenheimer bodies
* Cabot rings
* Hemoglobin precipitation
* Heinz body

Other|

* Rouleaux
* Reticulocyte
* Elevated ESR

Lymphocytes|

* Smudge cell
* Downey cell

Granulocytes|

* Hypersegmented neutrophil
* Pelger–Huet anomaly
* Döhle bodies
* Toxic granulation
* Toxic vacuolation
* Critical green inclusion

Small molecules|

| Blood sugar|

* Hypoglycemia
* Hyperglycemia
* Prediabetes
* Impaired fasting glucose
* Impaired glucose tolerance
* Oxyhyperglycemia

|

Nitrogenous|

* Azotemia
* Hyperuricemia
* Hypouricemia

Proteins|

| LFT|

* Elevated transaminases
* Elevated ALP
* Hypoproteinemia
* Hypoalbuminemia

|

Other|

* Elevated cardiac markers
* Elevated alpha-fetoprotein

Minerals|

* Iron overload disorder

Pathogens/sepsis|

* Bacteremia
* Viremia
* Fungemia
* Parasitemia
* Algaemia

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