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A case of solid blood.


A 53-year-old man with a noncontributory medical history presented to the hospital with blurry vision, intermittently blue fingers, and slowly progressive dyspnea. Blood test results showed the following: hematocrit, 16% (reference interval, 40%-51%); white blood cells, 15.5 x [10.sup.3]/[micro]L (reference interval, 4.2 x [10.sup.3]/[micro]L to 9.1 x [10.sup.3]/[micro]L); platelet count, 50 x [10.sup.3]/[micro]L (reference interval, 150 x [10.sup.3]/[micro], L to 330 x [10.sup.3]/[micro]L). The phlebotomists had a difficult time drawing the patient's blood because it would immediately solidify in the tubes (Figure 1).


1. What conditions could have caused blood to solidify in the tubes?

2. What test can help determine the patient's medical condition?

3. What steps could be taken to measure chemistry values in this sample?


Blood can form a gel when there are high concentrations of proteins, such as IgM and/or IgG antibodies, that precipitate at low temperatures (cryoglobulins) or agglutinate red blood cells (cold agglutinins) (1, 2). A bone marrow biopsy performed on this patient revealed Waldenstrom macroglobulinemia, which produces large amounts of IgM (3,4). Warming this patient's sample in a water bath, keeping it on heat packs during transport, and diluting it with warm diluent can reliquefy the sample.

Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

Authors' Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.


(1.) McPherson RA, Pincus MR, Henry JB. Henry's clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders Elsevier; 2007. p 537-8.

(2.) Stone MJ, Bogen SA. Evidence-based focused review of management of hyperviscosity syndrome. Blood 2012;119:2205-8.

(3.) Berentsen S, Tjonnfjord GE. Diagnosis and treatment of cold agglutinin mediated autoimmune hemolytic anemia. Blood Rev 2012;26: 107-15.

(4.) Gertz MA. Waldenstrom macroglobulinemia: 2011 update on diagnosis, risk stratification, and management. Am J Hematol 2011;86:411-6.

Nicole A. Yarid and Yan Zhang *

Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY.

* Address correspondence to this author at: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 608, Rochester, NY 14642. Fax 585-273-3003; e-mail yan1_

Received February 4, 2013; accepted February 7, 2013.

DOI: 10.1373/clinchem.2013.204396

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Title Annotation:the Clinical Chemist: What Is Your Guess?
Author:Yarid, Nicole A.; Zhang, Yan
Publication:Clinical Chemistry
Article Type:Clinical report
Date:Oct 1, 2013
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