Specimen Collection

Auckland City and Starship Hospitals:

10mL of blood in plain (red top) tube as serum is always required (for both cryoglobulin and cryofibrinogen)

Additional request for Cryofibrinogen:- 2 x 4mLs EDTA blood (lavender top) tube as plasma is also required.

Collection tubes should be pre-warmed to 37 ⁰ C before blood collection

Once blood is collected, it should be maintained at 37 ⁰ C in a heating block or thermal flask while being transported to the laboratory as soon as possible. Contact Phlebotomy on extn 25245 (ACH) or 22002 (SSH) to borrow a thermal flask.

Other collection centres please refer to Specimen Transport Instructions for Referring Laboratories section ( below)

Cryoglobulin / cryofibrinogen blood collection is NOT available from Labtests Auckland.

Community patients have to come directly to Outpatient Blood Collection Clinic, level 6 (next to Chapel), Building 1 (support building), Auckland City hospital, 2 Park Road, Grafton between 8am and 2:30pm on any weekdays for the blood collection . The centre does not open on weekends or public holidays.

There is no need to ring to book an appointment but as these specimens cannot be properly processed after 3pm, arrival before 2:30pm is essential .

10 mL Plain Blood (Always Required)

or 2 x 4mL

required for both cryoglobulin and cryofibrinogen

8 mL EDTA Blood

2 x 4mL EDTA

additional required for cryofibribnogen

Turnaround Time:

This test takes up to 8 days to perform all steps in the testing process.

Diagnostic Use and Interpretation

Cryoglobulins and cryofibrinogen are proteins which precipitate out when cooled below normal body temperature. They may precipitate out in small vessels and cause purpura or Raynaud's phenomenon, especially if the extremities of the body are exposed to a cold environment. Other clinical features include arthralgia and weakness.

There are 3 types of cryoglobulin:

1. Type I: consists of a single monoclonal immunoglobulin, usually an IgM.
2. Type II: immune complexes consisting of two different monoclonal immunoglobulins, or a monoclonal component plus polyclonal immunoglobulins.
3. Type III: polyclonal

The monoclonal components seen in Types I and II cryoglobulinaemia are most frequently IgM, and often have rheumatoid factor (anti-IgG) activity.

Causes of Cryoglobulinaemia:

Lymphoproliferative disorders e.g. Waldenstroms macroglobulinaemia and multiple myeloma are associated with type I cryoglobulins.

Reactive cryoglobulins may or may not have a monoclonal component. Causes include hepatitis C ( the commonest cause of cryocglobulinemia ), hepatitis B, autoimmune diseases and infections.

Labplus protocol for cryoglobulin testing

• A positive result is the presence of a precipitate in the serum/plasma after 7 days at 4 ⁰ C, which redissolves on warming to 37 ⁰ C.
• All specimens that test positive for cryoglobulin will be tested for rheumatoid factor.
• Protein electrophoresis to determine if a monoclonal component is present will be performed on all positive samples.
• Patients on anticoagulant therapy (especially intravenous heparin) may produce a false positive "cryoglobulin" due to complex formation between heparin and fibronectin.

Contact Information

Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.

If the query concerns a specific patient please include the NHI number in your email.

If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).

Individual chemical pathologists may be contacted but will not be available at all times.

After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.

Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402

Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052

Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427

Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427

Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427

Specimen Transport Instructions for Referring Laboratories

A. 10mL of blood in plain (red top) tube as serum is always required (for both cryoglobulin and cryofibrinogen)

B. Additional 10mL of blood in EDTA (lavender top) tube as plasma is also required for cryofibrinogen

C. Collection tubes should be pre-warmed to 37 ⁰ C before blood collection

D. Once blood is collected, it should be maintained at 37 ⁰ C in a heating block or thermal flask while being transported to the local laboratory as soon as possible

E. At the local laboratory, the serum should be incubated for at least 1 hour at 37 ⁰ C before centrifugation

F. Centrifugation should be maintained at 37 ⁰ C if possible.

G. Once the specimen is centrifuged, a minimum of 4mL of the serum (or plasma) should be separated from cells and aliquoted into a secondary tube

H. Ideally the secondary tube should be transported to Labplus while maintained at 37 ⁰ C. However, as it is not always practical to do so, it is acceptable for it to be transported at room temperature provided it is couriered to Labplus as soon as possible. The separated specimen should not be stored or transported at <=4 ⁰ C or frozen at any stage as cryoglobulins can become unrecoverable at those temperatures.

I. Labplus will reject samples received frozen or at <=4 ⁰ C.

J. Specimens received after 4 pm on Fridays or after 4pm on the day prior to statuatory holidays may not be processed.

Last updated at 15:26:00 06/01/2025