Newcastle Laboratories

Donath Landsteiner Investigation

Clinical Background:

Request Reasons:This test is performed to confirm a diagnosis of Paroxysmal Cold Haemoglobinuria (PCH). The patient for whom this procedure should be considered is one with a positive Direct Anti-g...

Request Reasons:This test is performed to confirm a diagnosis of Paroxysmal Cold Haemoglobinuria (PCH). The patient for whom this procedure should be considered is one with a positive Direct Anti-globulin Test (DAT) due to C3 (complement); demonstrable haemoglobinemia, haemoglobinuria, or both; and no evidence of autoantibody activity in plasma/serum or the eluate made from the DAT- positive cells. The Donath-Landsteiner test is the blood test used to detect harmful antibodies related to a rare disorder called Paroxysmal cold haemoglobinuria (PCH) which is a rare form of autoimmune haemolytic anaemia. It was characteristically associated with syphilis in the past, but nowadays is more often associated with acute viral infections. PCH can also present as an idiopathic cold haemagglutinin syndrome. The autoantibody that causes this syndrome is called the Donath Landsteiner antibody. This IgG autoantibody acts as biphasic haemolysins in vitro. The IgG autoantibodies bind to the RBCs at cold temperatures, and as the test is warmed to 37°C, complement is activated and lysis of the RBCs occurs. The autoantibody often has specificity for the P blood group antigen.

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Test Details

  • Discipline:

    Transfusion

    Transfusion

  • Specimen Container Adult:

    6mL No Anticoagulant (Red Top) and 6mL K2 EDTA (Pink Top)

    6mL No Anticoagulant (Red Top) and 6mL K2 EDTA (Pink Top)

  • Specimen Container Paediatric:

    6mL No Anticoagulant (Red Top) and 6mL K2 EDTA (Pink Top)

    6mL No Anticoagulant (Red Top) and 6mL K2 EDTA (Pink Top)

  • Minimum Volume Adult:

    6mL

    6mL

  • Minimum Volume Paediatric:

    4mL

    4mL

  • Special Requirement:

    Sample must be HANDWRITTEN and contain the patient's details.

    Sample must be HANDWRITTEN and contain the patient's details.

  • Sample Stability:

    Short term storage: Must be maintained at 37

    Short term storage: Must be maintained at 37

  • Transport Requirements:

    Sample should be hand delivered to Laboratory Medicine Reception to maintain storage conditions. Samples must not be subjected to extreme hot or cold conditions prior to testing.

    Sample should be hand delivered to Laboratory Medicine Reception to maintain storage conditions. Samples must not be subjected to extreme hot or cold conditions prior to testing.

  • Add On Test:

    DAT

    All urgent add ons via telephone must be confirmed via email to the appropriate email address

    RVIadditions.Laboratory@nuth.nhs.uk (internal)

    tnu-tr.bloodsciencesadditions@nhs.net (external)

    DAT

    All urgent add ons via telephone must be confirmed via email to the appropriate email address

    RVIadditions.Laboratory@nuth.nhs.uk (internal)

    tnu-tr.bloodsciencesadditions@nhs.net (external)

  • Interpretation:

    The Donath-Landsteiner assay is a specific test and should only be requested if there is a clinical suspicion of PCH. The test is considered positive when the patient’s serum, with or without added...

    The Donath-Landsteiner assay is a specific test and should only be requested if there is a clinical suspicion of PCH. The test is considered positive when the patient’s serum, with or without added complement, causes haemolysis in the test which was first incubated at 4°C then at 37°C with no haemolysis in the tests maintained at 37°C throughout. A positive test is indicative of Paroxysmal Cold Haemoglobinuria. The autoantibody is transient and can disappear quickly during the recovery from the acute illness, rendering a false negative Donath-Landsteiner test. The autoantibody rarely causes RBC agglutination above 4°C, and thus does not interfere with routine pre-transfusion tests. DAT is usually positive for C3, negative for IgG. An Eluate is normally negative. The antibody is not detected by routine antibody screen techniques.

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  • Factors Affecting Result:

    Key factors affecting the result: • Incorrect specimen type received • Specimen not received in laboratory within a temperature controlled flask/container or maintained at 37°C prior to separation ...

    Key factors affecting the result: • Incorrect specimen type received • Specimen not received in laboratory within a temperature controlled flask/container or maintained at 37°C prior to separation to avoid non reversible in-vitro autoadsorption. • Too small a serum volume to complete test. • Active complement is essential for demonstration of the antibody.

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  • Referenced Documents:

    4/1/15

    4/1/15

  • Routine Contact Name:

    Section Leader:

  • Routine Telephone:

    Freeman: 0191 213 7849
    RVI: 0191 282 43435

    Freeman: 0191 213 7849
    RVI: 0191 282 43435

  • Specialist Test:

    Yes

    Yes

  • Specialist Contact Name:

    transfusion manager

    transfusion manager

  • Specialist Telephone:

    0192 213 9169

    0192 213 9169

Availability:

Routine core hours Only The investigation MUST be pre-approved by a Haematology Consultant. Please discuss with Haematology Consultant if required out of hours.

Turn Around:

6 Hours

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