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Epic Code LAB1230866 Cold Agglutinin Titer, Serum

Important Note

To be collected at Hospital Sites only. In Grand Rapids, outpatients may only be collected at the 35 Michigan draw site.

Additional Codes

Mayo Code: CATTR

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Detection of cold agglutinins in patients with suspected cold agglutinin disease


This test is not recommended to diagnose Mycoplasma pneumoniae infections.

Specimen Type

Serum Red

Ordering Guidance

The cold agglutinin test is not specific for Mycoplasma pneumoniae and is not recommended to diagnose M pneumoniae infections. To diagnose M pneumoniae infections, order MPRP / Mycoplasmoides pneumoniae, Molecular Detection, PCR, Varies. For screening recent or past exposure to M pneumoniae, order MYCO / Mycoplasma pneumoniae Antibodies, IgG and IgM, Serum.

Specimen Required

Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 4 mL

Pediatric Volume: 1 mL

Collections Instructions:

1. Use a warm pack to keep specimen at 37° C prior to and after collecting.

2. Allow specimen to clot at 37° C.

3. Centrifuge at 37° C and aliquot serum into plastic vial immediately after blood clots or within one hour of collection.

4. Do not refrigerate prior to separation of serum from red cells.

Laboratory Test Directory Note:


COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.


Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 7 days
  Frozen  7 days
  Ambient  72 hours

Reject Due To

Gross hemolysis OK
Gross icterus OK

Day(s) Performed

Monday through Friday, Sunday

Reference Values

Titer results:

>64: Elevated

>1000: May be indicative of hemolytic anemia

Clinical Information

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. Symptoms may include 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.


Titers above 64 are considered elevated, but hemolytic anemia resulting from cold-reactive autoagglutinins rarely occurs unless the titer is 1000 or above. Titers below 1000 may be obtained when the autoantibody has a different specificity (eg, anti-i) or if the cold agglutinin is of the less-common low-titer, high-thermal-amplitude type.


The test is not a direct measure of clinical significance and must be used in conjunction with other in vitro and in vivo parameters.

Reporting Name

Cold Agglutinin Titer

Method Name

Titration/Red Cell Agglutination

Method Description

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 60 to 120 minutes at 2 to 8° C. The titer end point range is determined by hemagglutination.(Cohn CS, Delaney M, Johnson ST, Katz LM, eds: Technical Manual. 20th ed. AABB; 2020)

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
CATTR Cold Agglutinin Titer 14658-9


Result ID Test Result Name Result LOINC Value
CATTR Cold Agglutinin Titer In Process

Report Available

1 to 3 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

Clinical Reference

Cohn CS, Delaney M, Johnson ST, Katz LM, eds: Technical Manual. 20th ed. AABB; 2020


If not ordering electronically, complete, print, and send an Benign Hematology Test Request (T755) with the specimen.

Laboratory Test Catalog | West Additional Information:

Former code: LAB8490