Febrile/cold agglutininsCold agglutinins; Weil-Felix reaction; Widal's test; Warm agglutinins; Agglutinins
Agglutinins are antibodies that cause the red blood cells to clump together.
- Cold agglutinins are active at cold temperatures.
- Febrile (warm) agglutinins are active at normal body temperatures.
This article describes the blood test that is used to measure the level of these antibodies in the blood.
How the Test is Performed
A blood sample is needed. For information on how this is done, see: Venipuncture
How to Prepare for the Test
There is no special preparation.
How the Test will Feel
When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing where the needle was inserted.
Why the Test is Performed
This test is done to diagnose certain infections and find the cause of hemolytic anemia (a type of anemia that occurs when red blood cells are destroyed). Knowing whether there are warm or cold agglutinins can help explain why the hemolytic anemia is occurring and direct treatment.
- Warm agglutinins: no agglutination in titers at or below 1:80
- Cold agglutinins: no agglutination in titers at or below 1:16
The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.
What Abnormal Results Mean
An abnormal (positive) result means there were agglutinins in your blood sample.
Warm agglutinins may occur with:
- Infections, including brucellosis, rickettsial disease, salmonella infection, and tularemia
- Inflammatory bowel disease
- Systemic lupus erythematosus
- Use of certain medicines, including methyldopa, penicillin, and quinidine
Cold agglutinins may occur with:
- Infections, especially mononucleous and Mycoplasma pneumonia
- Chicken pox (varicella)
- Cytomegalovirus infection
- Cancer, including lymphoma and multiple myeloma
- Listeria monocytogenes
- Systemic lupus erythematosus
- Waldenstrom macrogolulinemia
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
If a disease linked to cold agglutinin is suspected, the person needs to be kept warm.
Baum SG. Mycoplasma infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 325.
Jäger U, Lechner. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr., Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 56th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2012:chap 44.
Schwartz RS. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 163.
Review Date: 5/15/2014
Reviewed By: Jennifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.