The presence of a cold agglutinin can affect the results returned from an automated hematology analyzer.
Factors affecting the impact:
(1) temperature of the specimen (more marked if specimen cold, may be less is warmed)
(2) concentration of the cold agglutinin
Hemogram pattern typical for the presence of a cold agglutinin:
(1) low hematocrit
(2) normal hemoglobin
(3) high MCV
(4) high MCHC
Other changes:
(1) pseudothrombocytosis
(2) pseudoleukocytosis
It is important to examine a peripheral blood smear when troubleshooting a patient with apparent anemia. A discrepancy between the platelet or white blood cell count on the smear and the analyzer result may be a clue. Another clue is the presence of red cell aggregates.
It can also be helpful to track hematology values over time. The values may behave erratically if a cold agglutinin is present.
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