Abstract
Background aims
Cold agglutinins are commonly identified in transfusion laboratories and are defined
by their ability to agglutinate erythrocytes at 3–4°C, with most demonstrating a titer
>64. Similarly, cryoglobulins can precipitate from plasma when temperatures drop below
central body temperature, resulting in erythrocyte agglutination. Thankfully, disease
associated from these autoantibodies is rare, but unfortunately, such temperature
ranges are routinely encountered outside of the body's circulation, as in an extracorporeal
circuit during hematopoietic progenitor cell (HPC) collection or human cell therapy
laboratory processing. When agglutination occurs ex vivo, complications with the collection and product may be encountered, resulting in adverse
events or product loss. Here, we endeavor to share our experience in preventing and
responding to known cases at risk of or spontaneous HPC agglutination in our human
cell therapy laboratory.
Case reports
Four cases of HPC products at risk for, or spontaneously, agglutinating were seen
at our institution from 2018 to 2020. Planned modifications occurred, including ambient
room temperature increases, tandem draw and return blood warmers, warm product transport
and extended post-thaw warming occurred. In addition, unplanned modifications were
undertaken, including warm HPC product processing and plasma replacement of the product
when spontaneous agglutination of the product was identified. All recipients successfully
engrafted after infusion.
Conclusions
While uncommon, cold agglutination of HPC products can disrupt standard processes
of collection and processing. Protocol modifications can circumvent adverse events
for the donor and minimize product loss. Such process modifications should be considered
in individuals with known risks for agglutination going to HPC donation/collection.
Key Words
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Article info
Publication history
Published online: April 10, 2023
Accepted:
March 7,
2023
Received:
August 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.
