Garratty G, Petz L D, Hoops J K
Br J Haematol. 1977 Apr;35(4):587-95. doi: 10.1111/j.1365-2141.1977.tb00623.x.
Cold agglutinin syndrome (CAS) is usually associated with IgM cold agglutinins with titres exceeding 1000 at 4 degrees C and a thermal amplitude of 30-32 degrees C. Occasionally patients are encountered who although having clinical and laboratory findings compatible with CAS do not have the characteristic serological findings. Thirty-two patients with a positive direct antiglobulin test due to complement sensitization were studied. Thirty-one of these patients had cold agglutinin titres greater than 64. Twenty-eight had haemolytic anaemia, including one patient with a cold agglutinin titre of only 8 against saline-suspended red cells. 53.6% of sera from patients with haemolytic anaemia reacted at 30 degrees C and 7.1% at 37 degrees C when albumin was not present, whereas in the presence of albumin all of the sera reacted at 30 degrees C and 67.9% reacted at 37 degrees C. None of the four patients without haemolytic anaemia reacted at 30 degrees C or 37 degrees C in the presence of albumin, even though one serum reacted to a titre of 1280 at 4 degrees C. Cold agglutinin titres and thermal amplitudes in the presence of bovine albumin were found to correlate better with haemolytic anaemia than reactions without albumin. If bovine albumin is utilized in compatibility testing, multiple cold autoabsorptions may be necessary before alloantibody activity at 37 degrees C can be excluded.
冷凝集素综合征（CAS）通常与IgM冷凝集素相关，其在4℃时滴度超过1000，热幅度为30 - 32℃。偶尔会遇到一些患者，尽管他们具有与CAS相符的临床和实验室检查结果，但却没有特征性血清学表现。对32例因补体致敏而直接抗球蛋白试验呈阳性的患者进行了研究。这些患者中有31例冷凝集素滴度大于64。28例有溶血性贫血，其中1例患者针对盐水悬浮红细胞的冷凝集素滴度仅为8。当不存在白蛋白时，溶血性贫血患者血清中53.6%在30℃时有反应，7.1%在37℃时有反应；而在有白蛋白存在时，所有血清在30℃时有反应，67.9%在37℃时有反应。4例无溶血性贫血的患者在有白蛋白存在时，即使1例血清在4℃时反应滴度达1280，但在30℃或37℃时均无反应。发现在有牛白蛋白存在时冷凝集素滴度和热幅度与溶血性贫血的相关性比无白蛋白时的反应更好。如果在相容性检测中使用牛白蛋白，在排除37℃时的同种抗体活性之前可能需要多次冷自身吸收。
