Test ID: CAGG
Cold Agglutinin Titer, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Detection of cold agglutinins in patients with suspected cold agglutinin disease
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CACNH | Screen | No | Yes |
| CATTH | Titer | No | Yes |
Method Name A short description of the method used to perform the test
CATTH/6168: Titration-Red Cell Agglutination at 4 Degrees C
CACNH/81174: Screen
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Red top
Specimen Volume: 4 mL
Collection Instructions: Do not refrigerate prior to separation of serum from red cells. Separate serum from red cells immediately after blood clots.
Additional Information: For diagnosis of Mycoplasma pneumoniae infection, see MYCPN/85107 Mycoplasma pneumoniae Antibodies, IgG and IgM, Serum.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | Serum gel tube |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum Red | Refrigerated (preferred) | |
| Ambient | ||
| Frozen | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
The cold agglutinin titer test is to be used as a tool in the evaluation of suspected cold agglutinin syndrome. In this syndrome, cold agglutinins, usually IgM with anti-I specificity, attach to the patient's erythrocytes causing a variety of symptoms, from chronic anemia due to premature removal of the sensitized erythrocytes from circulation by hemolysis to acrocyanosis of the ears, fingers, or toes due to local blood stasis in the skin capillaries.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
SCREEN
Negative
TITER
<1:64
Interpretation Provides information to assist in interpretation of the test results
Screen:
- Negative (no cold agglutinin detected)
- Positive (cold agglutinin detected, titer results will be reported)
Titer:
- Patients with cold agglutinin syndrome usually exhibit a titer value >1:512, with rare cases reportedly as low as 1:64.
- Normal individuals often have low levels of cold agglutinins.
The test is not a direct measure of clinical significance and must be used in conjunction with other in vitro and in vivo parameters.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Normal individuals may have low levels of cold agglutinins. The cold agglutinins test is not specific for Mycoplasma pneumoniae and is not recommended to diagnose Mycoplasma pneumoniae infections. See MYCPN/85107 Mycoplasma pneumoniae Antibodies, IgG and IgM, Serum.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Petz LD, Garratty G: Acquired Immune Hemolytic Anemias. New York, Churchill Livingstone, 1980
2. Farratty G, Petz LD, Hoops JK: The correlation of cold agglutinin titrations in saline and albumin with haemolytic anaemia. Br J Haematol 1977;35:587-595
Method Description Describes how the test is performed and provides a method-specific reference
A screen will be performed on all specimens first to identify most of those with titer values in the normal range. If the screen is negative, no titration will be performed and the screen will be reported as negative. If the screen is positive, a titer will be performed and the screen will be reported as positive.
The titer is determined by making serial doubling dilutions of the patient's serum in 0.9% saline. Group O indicator red cells are added and the serum-cell mixture is then incubated 20 minutes at 0 degress C to 5 degrees C, and the titer end point range is determined. (Ellenhorn MJ, Weiner D: Variables in determination of cold hemagglutinins. Am J Clin Pathol 1953;23:1031-1039)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday, Sunday, Continuously
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
86156-Screen
86157-Titer (if appropriate)
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| CACNH | Screen | 32672-8 |
| CATTH | Titer | 14658-9 |
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