Cryoglobulins, Serum + EDTA Plasma

Diagnostic Use

Cryoglobulins assesses both the presence of cryofibrinogen (plasma tube) and cryoglobulins (serum tube). For this reason sending both plasma AND serum is most informative.
Cryoglobulins should be considered for assessing patients with vasculitis, glomerulonephritis and lymphoproliferative disease. Consideration may also be given to patients presenting with unexplained purpura or vascular manifestations.
Where symptoms of cold exposure exist and macroglobulinaemia or multiple myeloma have been identified, cryoglobulins should be tested.

Department

Protein Lab

Delphic Registration Code

CRYP

Laboratory Handling

Phlebotomy

Please note: The laboratory is only able to receive these bloods Mon- Fri 8am - 3:30 pm. Follow cryoglobulin collection protocol using heated sand flasks, and pre-warmed tubes.

Registration

Send thermos flask directly to Protein lab ASAP on arrival into CHL. Samples from referral labs - PLEASE CAREFULLY CHECK TUBES FOR LABELLING THAT INDICATES SERUM and EDTA @ 37 oC.

Synonyms

Cryofibrinogen
Cryoprecipitates
Cryoproteins

Turnaround Time

10 days

Test Code

3216

Specimen Type

• Serum
• Plasma
• Whole Blood

Specimen Requirements

Tube/Container Type:

Preferred

• Serum (Red Cap)
• EDTA (Lavender Cap)

Preferred Sample Volume (ml)

1

Minimum Sample Volume (ml)

1

No of Samples Required

2

Interferences

Failure to follow specimen handling instructions may cause false negatives results.

Additional Specimen Information

Ensure vaccutainers and other blood sampling equipment is pre-warmed to 37°C. Equipment used for processing and separating samples should also be pre-warmed to 37°C to avoid cooling of the sample on contact and potential risk of precipitating out proteins of interest.
IF SAMPLES HAVE NOT BEEN SEPARATED THEY MUST BE KEPT AT 37°C.
Ensure all sampling equipment and vaccutainers are pre-warmed to 37°C, before collecting 5 mL of blood into an EDTA tube (purple top) and 5 mL of blood into a plain tube (red top).
Stand tubes for 40 minutes at 37°C to ensure that the plain tube is fully clotted, before separating.
Centrifuge samples for 5 minutes at 37°C, (DO NOT USE A REFRIDGERATED CENTRIFUGE, if absolutely necessary, ambient temperature is acceptable) then separate off the serum from the plain tube and transfer it into a tube labelled serum. Also separate off the plasma from the EDTA tube and label this plasma.
Once plasma and serum have been separated it is no longer necessary to retain these at 37°C.
Samples being sent to the laboratory for separation must be kept at 37°C. Using a thermos flask with sand heated to 37°C is presently the only suitable means of transferring these samples.
DO NOT refrigerate samples UNTIL they have been separated.

Aliquot Instructions

Sample Type

• Serum
• Plasma

Minimum Volume (ml)

1

Additional Referral/Aliquot Information

Ensure vaccutainers and other blood sampling equipment is pre-warmed to 37°C before collecting 5 mL of blood into an EDTA tube (purple top) and 5 mL of blood into a plain tube (red top). Equipment used for processing and separating samples should also be pre-warmed to 37°C to avoid cooling of the sample on contact and potential risk of precipitating out proteins of interest.

IF SAMPLES HAVE NOT BEEN SEPARATED THEY MUST BE KEPT AT 37°C.

Stand tubes for 40 minutes at 37°C to ensure that the plain tube is fully clotted, before separating.
Centrifuge samples for 5 minutes at 37°C, (DO NOT USE A REFRIDGERATED CENTRIFUGE, if absolutely necessary, ambient temperature is acceptable) then separate off the serum from the plain tube and transfer it into a tube labelled serum. Also separate off the plasma from the EDTA tube and label this plasma. Note on documentation that correct temperature protocol has been followed.
Once plasma and serum have been separated it is no longer necessary to retain these at 37°C.

Interpretation

Cryoglobulins are immunoglobulins that precipitate when cooled and dissolve when heated. Because these proteins precipitate when cooled, patients may experience symptoms when exposed to the cold. Cryoglobulins may be associated with a variety of diseases including plasma cell disorders, autoimmune diseases, and infections. Cryoglobulins may also cause erroneous results with some automated hematology instruments.

Cryoprecipitants may be identified as:

Cryofibrinogen: This is observed as a precipitant only in the plasma tube identified at 4°C. These are rare but may be associated with vasculitis.

Cryoglobulins are classified into 3 types:
-Type I (monoclonal)
-Type II (mixed monoclonal-polyclonal)
-Type III (polyclonal)

Type I: These are purely monoclonal immunoglobulins, usually associated with MGUS, macroglobulinaemia or multiple myeloma.

Type II: These are a mixture of 2 or more immunoglobulins, of which at least one is monoclonal. This type is usually associated with autoimmune disorders, such as; vasculitis, glomerulonephritis, systemic lupus erythematosus, rheumatoid arthritis and Sjorgren’s syndrome; infections, such as hepatitis, infectious mononucleosis, cytomegalovirus and toxoplasmosis. This condition may occur in the absence of any underlying disease.

Type III: These consist of one or more polclonal immunoglobulins. Generally these are present only in trace amounts. These are generally associated with the same conditions that Type II cryoglobulins are associated with.

Failure to identify cryoglobulins or cryofibrinogen may be due to failure to follow sample collection procedures. It is imperative that these are strictly adhered to.

Reference Intervals

Assay is qualitative only so no RI available.

Test Method

The normal proteins of plasma and serum do not precipitate in the cold. An aliquot of plasma and serum are incubated for 72 hrs at 4 degrees C. If a precipitate develops, the tube(s) are warmed to 37 degrees C to check that the precipitate redissolves, then incubated again at 4 degrees C to check precipitate reforms. All positive cryoglobulins are identified by electrophoresis and immunofixation.

Non-Funded Test Cost

$102.58 (Exclusive of GST)

Billing Code

3216

Contact Information

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