A Case of Cold Agglutinin Disease

Author: Christine Nebocat, DHEd, MLS(ASCP)CM, CHES®
Reviewer: Morgan Moss, MHA, MLS(ASCP)CM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Hematology): 1 hour(s)

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Objectives

  • Define cold agglutinin disease and outline the etiology of this disorder, with a focus on primary (idiopathic) versus secondary conditions.
  • Differentiate between acute and chronic cold agglutinin disease.
  • Outline the potential clinical features (signs, symptoms, pathophysiology) associated with cold agglutinin disease.
  • Evaluate hematology parameters and identify potentially skewed results due to a cold agglutinin.
  • Compare erroneous laboratory results caused by cold agglutinin disease to other potential patient sample interferences (i.e., proteinemia, lipemia).
  • Determine pre-examination specimen handling to correct for cold agglutinin interference.

Course Outline

  • Cold Agglutinin Disease
    • Introduction to Cold Agglutinin Disease
      • Cold Agglutinin Disease
      • Introduction to Autoantibody Production
      • Autoantibodies in Cold Agglutinin Disease
    • Pathophysiology
      • Pathophysiology
      • The immunoglobulin class most associated with cold agglutinin disease is:
      • Symptoms of CAD
    • Etiology
      • Etiology
      • Primary CAD
      • Secondary CAD
      • All of the following diagnoses could result in the production of cold agglutinins except:
    • Epidemiology
      • Incidence, Prevalence, and Prognosis
    • Monitoring and Treatment
      • Monitoring and Treatment
    • Lab Considerations
      • Pre-Testing Considerations in the Hematology Laboratory
      • Correcting an In Vitro Cold Agglutinin
      • Pre-Examination Interferences and Differentiating CAD
      • Pre-Examination Interferences and Comparison of Correction Techniques
      • The following technique would be most helpful in quickly identifying a cold agglutinin:
    • Case Study
      • Case Study: A Patient with Cold Agglutinin Disease
      • Initial Results
      • Rule of Three
      • Review the following CBC results. Which of the listed parameters violates the rule of three?ParameterResultReference RangeWBC5.804.0–10.0 × 103/mcLRBC1.43M: 4.6–6.1 × 106/mcL F: 3.9–5.2 × 106/mcL Hb12.3M: 14–18 g/dL F: 11–16 g/dL Hct13.5M: 40–51% F: 34–45% MCV94.4M: 80–94 fL F: 81–99 fL MCH86.027–35 pgMCHC91.133–36 g/
      • Technical Considerations and Cause of False Parameters
      • What do we know about the technology for measuring hemoglobin that explains why this parameter is not affected by cold agglutinin?
      • Post-Incubation Results
      • Evaluating Results of Post-Sample Treatment
      • Analyzer Results
    • Confirmation Testing
      • Laboratory Confirmation
      • Additional Laboratory Testing for Diagnosis
      • All of the following test results correlate with a diagnosis of CAD after a hemolytic episode except:
    • References
      • References

Additional Information

Level of Instruction: Basic
Intended Audience: Medical laboratory scientists, medical laboratory technicians, and any who work in hematology. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Christine M. Nebocat, DHEd, MLS(ASCP)CM, CHES®, is an Associate Professor in the Medical Laboratory Science program at Farmingdale State College SUNY. Her main areas of expertise are Hematology and Clinical Chemistry. She is responsible for organizing both laboratory and lecture sections of these disciplines within her department. As a generalist, Christine also maintains a per diem position in the field to stay up to date with current practices. She earned her Bachelor of Science in Medical Technology at Marist College, her Master of Science in Education at Dowling College, and her Doctoral degree in Health Education at A.T. Still University. In 2017, Christine was recognized by ASCP as one of the organization’s 40-Under-40 honorees.
Reviewer Information: Morgan Moss, MHA, MLS(ASCP)CM, is a Technical Training Specialist for Siemens Healthineers. She completed her Bachelor of Medical Technology at Old Dominion University. She then completed her graduate degree in Healthcare Administration at Grantham University. Prior to Siemens, Morgan worked as a generalist in the Department of Veterans Affairs. In her current position, she conducts classroom and onsite trainings throughout the continental U.S. Additionally, she edits and aligns training materials to represent real-world field/customer experiences, improves customer knowledge retention, and increases the successful operation of instrumentation.