Cold Agglutinins
- Also Known As:
- Agglutinins
- Cold Autoantibodies
- Cold-Reacting Antibodies

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.At a Glance
Why Get Tested?
To help determine the cause of hemolytic anemia; to help diagnose cold agglutinin disease
When To Get Tested?
When you have symptoms associated with anemia and/or pain, pale skin, and bluing in the fingers, toes and tips of the ears that occurs after exposure to cold temperatures; when you have been diagnosed with hemolytic anemia and your healthcare practitioner is investigating the cause
Sample Required?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
None
You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Testing.com. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.
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The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.
If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.
Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.
While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”
For more information, please read the article Reference Ranges and What They Mean.
What is being tested?
Cold agglutinins are autoantibodies produced by a person’s immune system that mistakenly target red blood cells (RBCs). They cause RBCs to clump together when a person is exposed to cold temperatures and increase the likelihood that the affected RBCs will be destroyed by the body. This test detects and measures the amount of cold agglutinins in the blood.
When the presence of cold agglutinins in a person’s blood leads to significant RBC destruction, it can cause hemolytic anemia and lead to a low RBC count and hemoglobin. This rare form of autoimmune hemolytic anemia is known as cold agglutinin disease. Cold agglutinin disease may be primary or secondary, induced by some other disease or condition.
Primary cold agglutinin disease typically affects those who are middle age to elderly, and it tends to continue over time (chronic). Secondary cold agglutinin disease may affect anyone and may be acute or chronic, temporary or persistent. It may cause hemolytic anemia to a greater or lesser degree and is associated with a variety of conditions.
The cold agglutinin test is not routinely ordered. It is a test that has been available for a long time, but it has become less commonly used as more specific tests for secondary causes, such as Mycoplasma pneumoniae infection, have become available.
Common Questions
View Sources
Sources Used in Current Review
Aljubran, S. and Lockey, R. (2017 April 21, Updated). Cold Agglutinin Disease. Medscape Hematology. Available online at http://emedicine.medscape.com/article/135327-overview#showall. Accessed on 6/25/17.
Blaylock, R. et. al. (2016 August Updated). Cold Agglutinin Disease. ARUP Consult. Available online at https://arupconsult.com/content/cold-agglutinin-disease. Accessed on 6/25/17.
Lal, S. (2016 May 11 Updated). Febrile/cold agglutinins. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/003549.htm. Accessed on 6/25/17.
(© 1995–2017). Cold Agglutinin Tier, Serum. Mayo Clinic Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/6168. Accessed on 6/25/17.
Schick, P. (2016 May 26, Updated). Hemolytic Anemia. Medscape Hematology. Available online at http://emedicine.medscape.com/article/201066-overview. Accessed on 6/25/17.
Swiecicki, P. et. al. (2013). Cold agglutinin disease. Blood 2013 122:1114-1121. Available online at http://www.bloodjournal.org/content/122/7/1114?sso-checked=true. Accessed on 6/25/17.
Sources Used in Previous Reviews
Vorvick, L. (Updated 2012 May 31). Febrile/cold agglutinins. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003549.htm. Accessed August 2013.
Aljubran, S. and Lockey, R. (MD : (Updated 2013 January 25) Cold Agglutinin Disease Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/135327-overview. Accessed August 2013.
Delgado, J. and Hill, H. (Updated 2013 July). Cold Agglutinin Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ColdAgglutinin.html?client_ID=LTD. Accessed August 2013.
Schick, P. et. al. (Updated 2013 February 21) Hemolytic Anemia. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/201066-overview. Accessed August 2013.
(© 1995-2013) Cold Agglutinin Titer, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8992. Accessed August 2013.
Lichtin, A. (Revised 2009 February). Autoimmune Hemolytic Anemia. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed August 2013.
Stone, M. (2010 October 28). Heating up cold agglutinins. Blood v 116 (17) 3119-3120. [On-line information]. Available online at http://bloodjournal.hematologylibrary.org/content/116/17/3119.full. Accessed August 2013.
Waites, K. (Updated 2012 September 28). Mycoplasma Infections. Medscape Reference. [On-line information]. Available online at http://emedicine.medscape.com/article/223609-overview. Accessed August 2013.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 279-280.
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