{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T02:10:36Z","timestamp":1771467036161,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T00:00:00Z","timestamp":1659398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cold agglutinin syndrome (CAS) is associated with various diseases. Several studies of CAS associated with coronavirus disease 2019 (COVID\u201019) reported hemolytic anemia and thrombosis; however, the clinical significance of cold agglutinins (CA) in patients with COVID\u201019 is unclear. Here, we present two cases of CA identified in the context of COVID\u201019 without hemolytic anemia and clotting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report and Discussion<\/jats:title><jats:p>Two patients with no known risk factors for CA were diagnosed with COVID\u201019; peripheral blood smears reveal red blood cells (RBCs) agglutination. These patients showed a high CA titer. We confirmed retrospectively that the CA was an anti\u2010I antibody. The two COVID\u201019 cases with a high CA titer showed no hemolysis or thrombosis. Mycoplasma pneumoniae is known to cause CAS, but not all patients who have a high CA titer show hemolysis. Coagulation abnormalities are documented in severe COVID\u201019 cases. Although CA increases the risk of thrombosis in those with lymphoproliferative diseases, the role of anti\u2010I antibodies in COVID\u201019 is unclear. The impact of CAS on clinical presentations in COVID\u201019 remains a matter of verification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A high CA titer was identified in COVID\u201019 patients without hemolytic anemia and clotting. Anti\u2010I antibodies were identified. Further studies are required to clarify the pathophysiology of CA in COVID\u201019.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcla.24629","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T19:49:56Z","timestamp":1659469796000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cold agglutinin <scp>anti\u2010I<\/scp> antibodies in two patients with <scp>COVID<\/scp>\u201019"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2616-6311","authenticated-orcid":false,"given":"Hiroharu","family":"Imoto","sequence":"first","affiliation":[{"name":"Department of Hematology Kobe City Medical Center General Hospital  Kobe Japan"},{"name":"Department of Hematology and Clinical Immunology Nishi Kobe Medical Center  Kobe 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