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Cold Agglutinins

Rita Burns sent me this message on January 8: How do you handle a strong cold agglutinin for coagulation testing?  This particular sample generated dye errors on the Biomerieux (Trinity Biotech, Inc) MDA180.  After warming the sample on the unit, we were able to retrieive results with no error flags, but we are still concerned as to its effect of falsely prolonging results.

This is a new one for me, Rita. The dye error is an internal quality system the MDA employs to detect specimen errors such as hemolysis, icterus, and lipemia, however I’ve not known of a coagulation test to be affected by cold agglutinins, not to say it couldn’t happen. I do think you have handled the specimen correctly by incubating it, however if you are uncertain, you may wish to re-collect and hold it at 37 degrees centrigrade until you can get it on the instrument. Geo.

Here is a convenient explanation of dye errors provided by Kim Kinney at Clarian in Indianapolis:

The PT and PTT reagents have a blue dye with a value we enter in the database. The MDA then establishes +/-2SD for the dye and tracks whether there is too much color (icteric, hemolyzed and lipemia), not enough sample or bubbles. The optical scanner verifies the correct volume of sample and reagent is delivered based on the light transmission of the dye at its absorbtion wavelength, and when it is lower or higher than that range, a dye error is thrown.  We see it most often on hemolyzed samples, and dye errors on hemolysis are rejected.  You can also get just an “H”, “B” and “L” flag for hemolysis, bilirubin and lipemia…these samples are run and the results qualified with a comment. You also see dye errors when there are bubbles in samples. Extremely colored samples also throw dye errors. Kim.

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