Collection and processing of hematopoietic progenitor cell products at risk of presenting with cold agglutination

Thomas Z Thompson; Ashley A Krull; Dustin J Strasburg; Jill Adamski; Eapen K Jacob; Margaret A DiGuardo

doi:10.1016/j.jcyt.2023.03.003

Collection and processing of hematopoietic progenitor cell products at risk of presenting with cold agglutination

Cytotherapy. 2023 Jul;25(7):699-703. doi: 10.1016/j.jcyt.2023.03.003. Epub 2023 Apr 10.

Authors

Thomas Z Thompson¹, Ashley A Krull¹, Dustin J Strasburg¹, Jill Adamski², Eapen K Jacob¹, Margaret A DiGuardo³

Affiliations

¹ Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
² Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
³ Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA. Electronic address: diguardo.margaret@mayo.edu.

PMID: 37045729
DOI: 10.1016/j.jcyt.2023.03.003

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.

Keywords: agglutination; cold agglutinin; cryoglobulin; hematopoietic progenitor cell.

MeSH terms

Agglutination
Cold Temperature
Erythrocytes*
Hematopoietic Stem Cells*
Humans
Temperature