Table II.
Diagnosis of primary CAD.
| Comments and precautions | ||
|---|---|---|
| Criteria | Chronic hemolysis | |
| Cold agglutinin titer ≧ 64 at 4°C | ||
| Typical DAT findings: | Specific DAT for IgG is usually, but not always, negative | |
| Polyspesific DAT positive | ||
| Specific DAT positive for C3d | ||
| No malignant disease by clinical and radiological assessment | ||
| Procedures: blood and serum | Hemoglobin level and blood cell counts | |
| Routine assessment for hemolysis | ||
| DAT. Specific DAT for C3d and IgG | ||
| Cold agglutinin (CA) titer at 4°C | Blood specimens for CA and immunoglobulin analyses must be kept at 37°C from sampling until serum has been removed from the clot | |
| Complement assessments (C3, C4 and CH50) | ||
| Electrophoresis with immunofixation | ||
| Quantification of IgM, IgG and IgA | Immunofixation should be performed even if no monoclonal band is visible on electrophoresis | |
| Procedures: bone marrow | Trephine biopsy (including immunohistochemistry) | Morphology and immunohisto-chemistry of trephine biopsies should be assessed by an experienced hemopathologist |
| Flow cytometry of aspirate | ||
| Radiology | Chest X-ray | |
| Abdominal ultrasonography |