UNIVERSITAS AIRLANGGA



Detail Article

Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 18 / No. 3 / Published : 2012-01

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Original Article :

Cold agglutinins in a community acquired pneumonia patient

Author :

  1. Johanis*1
  2. J. Soemarsono*2
  1. Bag PK FK-UNAIR/RSU Dr. Soetomo Surabaya
  2. Bag PK FK-UNAIR/RSU Dr. Soetomo Surabaya

Abstract :

Cold agglutinins at below physiologic body temperature can cause spontaneous agglutinations of erythrocytes. Cold agglutinins result from a particular antibodies activation on erythrocytes associated with a primary disease, including infection. The generation of antibody activates complement resulting in hemolysis. A 63-year-old man suffered from shortness of breath accompanied with productive cough, fever, right chest pain, loss of appetite, nausea, and occasionally vomiting. Physical examination showed an increase of pulse rate, respiration rate, and body temperature. Lung examination showed right intercostals retraction and rales in both lungs, but no abnormality detected in other organs. Chest X-ray showed pneumonia. EDTA whole blood showed spontaneous agglutinations at room temperature, however this did not occur by maintaining temperature at 37°C. Different complete blood count results were shown between agglutinated blood and absent of agglutination blood samples. As anti-I, anti-i, and/or anti-H was suspected, agglutinations for anti-A and anti-AB occurred by using ABO forward grouping test, whereas reverse grouping showed agglutinations for A, B, and O cells. Protein electrophoresis showed increase of alpha-1 and gamma globulin; decrease of renal function; slightly increase of indirect bilirubin; and suspected Extended Spectrum Beta-Lactamase (ESBL) Klebsiella pneumoniae. The diagnosis of this case was community acquired pneumonia and suspected ESBL. Cold agglutinins affected CBC evaluations mostly shown in the erithrocyte index, nevertheless this could prevented by maintaining at physiologic body temperature. Infection could induce activation of cold agglutinins.       Aglutinin dingin (Cold agglutinin) menyebabkan pergumpalan (aglutinasi) sel darah merah (eritrosit) spontan yang terjadi di bawah suhu tubuh fisiologis. Cold agglutinin disebabkan oleh aktivasi antibodi tertentu terhadap sel darah merah akibat penyakit dasar, misalnya infeksi. Pembentukan antibodi mengaktifkan komplemen dan menyebabkan penguraian darah (hemolisis). Kasus ini menyajikan laporan seorang laki-laki berusia 63 tahun menderita sesak napas disertai batuk berdahak, demam, nyeri dada kanan, nafsu makan menurun, mual, dan kadang muntah. Pemeriksaan fisik didapatkan peningkatan denyut nadi, kekerapan napas, dan suhu badan. Pemeriksaan paru menunjukkan retraksi interkostal dekstra dan ronkhi bilateral, sedangkan periksaan organ lain dalam batas normal. Gambar rontgen dada menunjukkan radang jaringan paru (pneumonia). Pemeriksaan darah EDTA menunjukkan aglutinasi sel darah merah spontan  pada suhu ruangan, tetapi aglutinasi dengan mempertahankan suhu 37°C tidak terjadi. Terdapat perbedaan hasil hitungan darah lengkap (complete blood count) antara aglutinasi sel darah merah dan darah tanpa keadaan tersebut. Kecurigaan terhadap anti-I, anti-i, dan atau anti-H diuji dengan pengelompokan depan (forward grouping) ABO yang menunjukkan aglutinasi di anti-A dan anti-AB, sedangkan uji pengelompokan sebaliknya (reverse grouping) menunjukkan aglutinasi di sel A, B, dan O. Elektroforesis protein menunjukkan peningkatan alfa-1 dan gamma globulin; penurunan fungsi ginjal; peningkatan ringan bilirubin tidak langsung; dan kecurigaan Beta-Laktamase berspektrum luas/Extended Spectrum Beta-Lactamase (ESBL) Klebsiella pneumoniae. Diagnosis klinis penderita adalah community acquired pneumonia dengan kecurigaan ESBL. Cold agglutinin mempengaruhi periksaan CBC terutama indeks sel darah merah, tetapi dapat dicegah dengan mempertahankan derajat suhu fisiologis tubuh. Infeksi mencetuskan aktivasi cold agglutinin.

Keyword :

Cold agglutinins, community acquired pneumonia, ESBL,


References :

Sheehan C,(1990) Clinical Immunology: Principles and Laboratory Diagnosis USA : J.B.Lippincott Company

McPherson R.A., Pincus W.R,(2006) Henry’s Clinical Diagnosis and Management by Laboratory Methods USA : Saunders Elsevier

Harmening D.M,(1999) Modern Blood Banking and Transfusion Practices Thailand : Promotion and Service Cp., Ltd

Harper J.L,(2010) Cold Agglutinin Disease http://emedicine.medscape.com/article/954954-overview : eMedicine from WebMD

5. Fauci A.S., Braunwald E., Isselbacher K.J., Wilson J.D., Martin J.B., Kasper D.L., Hauser S.L., L,(1998) Harrison’s Principles of Internal Medicine USA : McGraw-Hill





Archive Article

Cover Media Content

Volume : 18 / No. : 3 / Pub. : 2012-01
  1. Prothrombin Time And Activated Partial Thromboplastin Time Test’s Result Using Humaclot Va And Sysmex Ca 500
  2. Association Hla-drb1* And Hla-dqb1* With Serum Igm-rf With Rheumatoid Arthritis
  3. Platelets Of Dengue Hemorrhagic Fever
  4. The Diagnostic Value Of Tb Antigen Using Rapid Test Device (tb Ag) For Pulmonary Tuberculosis
  5. Antimicrobial Susceptibility Test Of Pathogenic Aerobic Bacteria At The Internal Medicine Ward
  6. Correlation Of Liver Functions Test, And The Grade Of Dengue Hemorrhagic Fever In Children
  7. Pulmonary Cryptosporidiosis In Tbc Patients
  8. Mycobacterium Tuberculosis And Pcr
  9. Oral Immunization With 38-kda Adhesin Protein Of Mycobacterium Tuberculosis On Cd8+ T Cells In Lung
  10. Thrombocytes Count In Acute Coronary Syndrome Related To Low Molecular Weight Heparin (lmwh)}
  11. Acute Fatty Liver Of Pregnancy
  12. Cold Agglutinins In A Community Acquired Pneumonia Patient

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