title: Cold Agglutinin Disease; A Laboratory Challenge.
abstract: BACKGROUND
  Autoimmune haemolytic anemia (AIHA) is a complex process characterized by an immune reaction against red blood cell self-antigens. The analysis of specimens, drawn from patients with cold auto-immune hemolytic anemia is a difficult problem for automated hematology analyzer. This paper was written to alert technologists and pathologists to the presence of cold agglutinins and its effect on laboratory tests.
  
  
  METHODS
  A 72-year-old female presented to the Shafa laboratory for hematology profile evaluation. CBC indices showed invalid findings with the Sysmex automated hematology analyzer. Checking the laboratory process showed precipitation residue sticking to the sides of the tube. After warming the tubes, results become valid and the problem attributed to cold agglutinin disease. In this situation, aggregation of RBCs, which occurs at t < 30°C, causes invalid findings meanwhile working with automated hematology analyzer.
  
  
  CONCLUSIONS
  Knowledge of this phenomenon can help prevent wasting too much time and make an early and accurate diagnosis.
authors.affiliation: Department of Clinical Sciences, Veterinary Faculty, Razi University, Kermanshah, IR Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Nikousefat
authors.affiliation: Department of Veterinary Surgery and Radiology, Veterinary Faculty, Shahrekord University, Shahrekord, IR Iran.
authors.forename: Moosa
authors.initials: M
authors.lastname: Javdani
authors.affiliation: Department of Pathobiology, Veterinary Faculty, Razi University, Kermanshah, IR Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hashemnia
authors.affiliation: Department of Pathology, Sajad Hospital, Kermanshah, IR Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Haratyan
authors.affiliation: Department of Clinical Sciences, Veterinary Faculty, Razi University, Kermanshah, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Jalili
keywords: Cold Agglutinin Disease; Hemolytic Anemia; Sysmex Autoanalyzer