Red cell agglutination in infectious mononucleosis

A 16-year-old boy presented with 2 weeks of fevers, night sweats, fatigue, and myalgia, in addition to an erythematous rash on the trunk and extremities after new findings of hepatosplenomegaly and inguinal lymphadenopathy. Monospot test was positive, confirming the diagnosis of infectious mononucleosis.

Red cell agglutinins are infrequently seen in infectious mononucleosis (∼1% of cases) and have been ascribed to polyclonal IgG/IgM cold agglutinins specific for the i antigen on the red cells. The weakly positive DAT using anti-C3d and the negative DAT using anti-IgG are characteristic for infectious mononucleosis, indicative of complement-mediated intravascular hemolysis that can occur 1 to 2 weeks after infection.

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Red cell agglutination in infectious mononucleosis

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Source: Blood Journal