hematology Hematology ( always spelled haematology in British English) is the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to blood. It involves treating diseases that affect the pro ...

, red cell agglutination or autoagglutination is a phenomenon in which

red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...

s clump together, forming aggregates. It is caused by the surface of the red cells being coated with antibodies. This often occurs in

cold agglutinin disease Cold agglutinin disease (CAD) is a rare autoimmune disease characterized by the presence of high concentrations of circulating cold sensitive antibodies, usually IgM and autoantibodies that are also active at temperatures below , directed again ...

, a type of

autoimmune hemolytic anemia Autoimmune hemolytic anemia (AIHA) occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst (lyse), leading to an insufficient number of oxygen-carrying red blood cells in the circulation. The lifetime o ...

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 disorder Lymphoproliferative disorders (LPDs) refer to a specific class of diagnoses, comprising a group of several conditions, in which lymphocytes are produced in excessive quantities. These disorders primarily present in patients who have a compromised ...

s, from infection with ''

Mycoplasma pneumoniae ''Mycoplasma pneumoniae'' is a very small bacterium in the class Mollicutes. It is a human pathogen that causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia related to cold agglutinin disease. ''M. pneumoniae'' is c ...

'' or

Epstein–Barr virus The Epstein–Barr virus (EBV), formally called ''Human gammaherpesvirus 4'', is one of the nine known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. EBV is a double-stranded DNA virus. It is ...

, or

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. From Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approximately "a disease of its own kind ...

ally (without any apparent cause). Red cell agglutination can also occur in

paroxysmal nocturnal hemoglobinuria Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, life-threatening disease of the blood characterized by destruction of red blood cells by the complement system, a part of the body's innate immune system. This destructive process occu ...

and warm autoimmune hemolytic anemia. In cases of red cell agglutination, the direct antiglobulin test can be used to demonstrate the presence of antibodies bound to the red cells. __TOC__

Interference with laboratory tests

Red blood cell aggregates are counted as single cells by the

automated analyzer An automated analyser is a medical laboratory instrument designed to measure different chemicals and other characteristics in a number of biological samples quickly, with minimal human assistance. These measured properties of blood and other fluids ...

s used to run

complete blood count A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and ...

tests. This leads to a markedly decreased

count and

hematocrit The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is nor ...

and markedly elevated mean cell volume and mean cell hemoglobin concentration. Red cell agglutination also interferes with routine methods for blood typing and

blood compatibility testing Blood compatibility testing is conducted in a medical laboratory to identify potential incompatibilities between Human blood group systems, blood group systems in blood transfusion. It is also used to diagnose and prevent some complications of pr ...

, which rely on agglutination reactions. People with red cell agglutination may exhibit spontaneous agglutination reactions during testing, leading to a false positive result. If the causative antibodies are only active at room temperature, the agglutination can be reversed by heating the blood sample to . People with warm autoimmune hemolytic anemia may exhibit red cell agglutination that does not resolve on warming.

References

Hematology {{Pathology-stub