coombs test


Summary: A test to detect non-agglutinating ANTIBODIES against ERYTHROCYTES by use of anti-antibodies (the Coombs' reagent.) The direct test is applied to freshly drawn blood to detect antibody bound to circulating red cells. The indirect test is applied to serum to detect the presence of antibodies that can bind to red blood cells.

Top Publications

  1. Zulty J, Kociba G. Cold agglutinins in cats with haemobartonellosis. J Am Vet Med Assoc. 1990;196:907-10 pubmed
    ..These data indicate that cold agglutinins are associated with haemobartonellosis and suggest that immunologic responses to erythrocytic antigens have a role in the anemia...
  2. Orduña A, Almaraz A, Prado A, Gutierrez M, Garcia Pascual A, Duenas A, et al. Evaluation of an immunocapture-agglutination test (Brucellacapt) for serodiagnosis of human brucellosis. J Clin Microbiol. 2000;38:4000-5 pubmed
    ..If a >/=1/160 diagnostic threshold titer was defined for the Brucellacapt test, Coombs test, and SAT, the sensitivities were 95.1, 91.5, and 65.8%, respectively...
  3. Araj G, Kattar M, Fattouh L, Bajakian K, Kobeissi S. Evaluation of the PANBIO Brucella immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays for diagnosis of human brucellosis. Clin Diagn Lab Immunol. 2005;12:1334-5 pubmed
    ..The sensitivities of ELISA IgG and IgM were 91% and 100%, respectively, while the specificity was 100% for both. These ELISAs are simple, rapid, and reliable for the diagnosis of human brucellosis. ..
  4. Casao M, Navarro E, Solera J. Evaluation of Brucellacapt for the diagnosis of human brucellosis. J Infect. 2004;49:102-8 pubmed
    ..serum samples collected at the time of diagnosis and at intervals during and after treatment were tested by the Coombs test, the standard seroagglutination test (SAT), and Brucellacapt (a new test based on an immunocapture-..
  5. Issitt P, Combs M, Bredehoeft S, Campbell M, Heimer M, Joyner L, et al. Lack of clinical significance of "enzyme-only" red cell alloantibodies. Transfusion. 1993;33:284-93 pubmed
    ..These data support a belief, generally held in the United States but not necessarily elsewhere, that the use of protease-treated red cells for routine pretransfusion tests creates far more work than the accrued benefits justify. ..
  6. von Vigier R, Fossali E, Crosazzo L, Bianchetti M. Positive Coombs test in postpneumococcal hemolytic-uremic syndrome. Pediatr Infect Dis J. 2005;24:1028-9 pubmed
  7. Ardic N, Ozyurt M, Sezer O, Erdemoglu A, Haznedaroglu T. Comparison of Coombs' and immunocapture-agglutination tests in the diagnosis of brucellosis. Chin Med J (Engl). 2005;118:252-4 pubmed
  8. Abbas S, Zeeshan R, Sultan S, Irfan S. Direct Coombs Test Positivity in B-Chronic Lymphoid Leukemia: a Marker of Advanced Clinical Disease. Asian Pac J Cancer Prev. 2015;16:6007-10 pubmed
    ..This study was carried out to determine the frequency of direct Coombs Test positivity in CLL patients and its possible correlation with Rai staging, hematological parameters and ..
  9. Chen J, Fu R, Li L, Liu H, Wang Y, Wang H, et al. [Variation in complement level and its significance in cytopenia patients with positive BMMNC-Coombs]. Zhonghua Xue Ye Xue Za Zhi. 2009;30:454-7 pubmed
    To investigate the variation of bone marrow complement level in cytopenia patients with positive BMMNC-Coombs test (CBCPC), and probe the role of complement in destroying hematopoietic cells of CBCPC patients...

More Information


  1. Al Sayes F, Hindawi S, Damanhouri G, Attallah S, Azaher F, Akbar D. Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?. Saudi Med J. 2012;33:182-5 pubmed
    ..Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease. ..
  2. Ciuchini F, Adone R, Pasquali P. Coombs antiglobulin test using Brucella abortus 99 as antigen to detect incomplete antibodies induced by B abortus RB51 vaccine in cattle. Clin Diagn Lab Immunol. 2002;9:1398-9 pubmed
    ..This study showed that vaccination of cattle with Brucella abortus rough strain RB51 induces incomplete antibodies that can be detectable by a Coombs antiglobulin test using the B. abortus 99 smooth strain. ..
  3. Mayer B, Leo A, Herziger A, Houben P, Schemmer P, Salama A. Intravascular immune hemolysis caused by the contrast medium iomeprol. Transfusion. 2013;53:2141-4 pubmed publisher
    ..The hemolysis in that patient was related to Isopaque, an older ionic CM. Here, we describe an additional patient and recommend that CM should be considered as a rare risk in the development of IHA. ..
  4. Luzo A, Pereira F, de Oliveira R, Azevedo P, Cunha R, Leonardi M, et al. Red blood cell antigen alloimmunization in liver transplant recipients. Transplant Proc. 2010;42:494-5 pubmed publisher
    ..The incidence of alloimmunization (23%) was slightly higher among patients than in the literature, most probably as a consequence of our ethnic heterogeneity. ..
  5. Alwar V, Puttaiah P, Prasanna P, Devi S, Sitalakshmi S, Rameshkumar K. Gel card technology for Coombs test. Indian J Pathol Microbiol. 2007;50:663-4 pubmed
  6. Wainer S, Rabi J, Lyon M. Coombs' testing and neonatal hyperbilirubinemia. CMAJ. 2007;176:972-3; author reply 973 pubmed
  7. Rottenberg Y, Yahalom V, Shinar E, Barchana M, Adler B, Paltiel O. Blood donors with positive direct antiglobulin tests are at increased risk for cancer. Transfusion. 2009;49:838-42 pubmed publisher
    ..2-20.6; p = 0.003) for hematologic malignancies. There is evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT even within a short follow-up period. ..
  8. Kondo H, Oyamada T, Mori A, Sumi H, Kurosu K, Kajii E, et al. Direct-antiglobulin-test-negative immune haemolytic anaemia and thrombocytopenia in a patient with Hodgkin's disease. Acta Haematol. 2001;105:233-6 pubmed
  9. Wikman A, Axdorph U, Gryfelt G, Gustafsson L, Bjorkholm M, Lundahl J. Characterization of red cell autoantibodies in consecutive DAT-positive patients with relation to in vivo haemolysis. Ann Hematol. 2005;84:150-8 pubmed
    ..This may be of importance in understanding the mechanisms of haemolysis and in predicting the harmfulness of antibodies, especially when blood transfusions are needed. ..
  10. Gustafsson L, Wikman A, Lundahl J. Evaluation of a modified IAT-gel with polyethylenglycol (PEG) addition method for red blood cell antibody identification. J Clin Lab Anal. 2004;18:165-9 pubmed
    ..We concluded that the PEG-IAT in gel method identifies more RBC antibodies with less nonspecific reactions than the two-stage enzyme technique. However, no single method detected all clinical significant RBC antibodies. ..
  11. Coppo P, Clauvel J, Bengoufa D, Fuentes V, Gouilleux Gruart V, Courvalin J, et al. Autoimmune cytopenias associated with autoantibodies to nuclear envelope polypeptides. Am J Hematol. 2004;77:241-9 pubmed
    ..Their detection strongly suggests an autoimmune process. Such cytopenias are often manifestations of a lupus or lupus-like disease and are responsive to steroids. ..
  12. Llopis F, Carbonell Uberos F, Montero M, Terrón I. Standardization of anti-human globulin sera for phenotyping red blood cells using a new method. Vox Sang. 2002;82:52 pubmed
  13. Schutzman D, Sekhon R, Hundalani S. Hour-specific bilirubin nomogram in infants with ABO incompatibility and direct Coombs-positive results. Arch Pediatr Adolesc Med. 2010;164:1158-64 pubmed publisher
    ..This finding has direct clinical applicability to the health care professional practicing in the newborn nursery. ..
  14. Vaglio S, Arista M, Perrone M, Tomei G, Testi A, Coluzzi S, et al. Autoimmune hemolytic anemia in childhood: serologic features in 100 cases. Transfusion. 2007;47:50-4 pubmed
    ..This series, much larger than any previously reported, is critically reviewed and analyzed to delineate the immunologic features of the disease in childhood. ..
  15. Bartolmäs T, Salama A. A dual antiglobulin test for the detection of weak or nonagglutinating immunoglobulin M warm autoantibodies. Transfusion. 2010;50:1131-4 pubmed publisher
    ..Weak or nonagglutinating RBC-bound IgM warm antibodies can be identified by the presented DDAT. ..
  16. Carvalho J, Catre D, Pereira C, Costa M. Anesthesia in patients with positive direct coombs test: report of three cases. Rev Bras Anestesiol. 2010;60:75-83 pubmed
    ..and discuss the conduct in three patients undergoing surgical intervention for neoplastic disease with positive Coombs Test (CT), and the impossibility to determine the blood type...
  17. Ulu Kılıç A, Metan G, Alp E. Clinical presentations and diagnosis of brucellosis. Recent Pat Antiinfect Drug Discov. 2013;8:34-41 pubmed
    ..from peripheral blood and other tissues. Recent patents are especially based on molecular assays in the diagnosis of brucellosis. However, PCR is still expensive and may not be appropriate for daily practice. ..
  18. Gómez Puerta J, Martin H, Amigo M, Aguirre M, Camps M, Cuadrado M, et al. Long-term follow-up in 128 patients with primary antiphospholipid syndrome: do they develop lupus?. Medicine (Baltimore). 2005;84:225-30 pubmed
    ..aCL IgM in 36 (39%), lupus anticoagulant in 71 (65%), antinuclear antibodies in 47 (37%), and positive Coombs test in 5 (4%) patients. During the follow-up and after a median disease duration of 8...
  19. Moulds M. Review: monoclonal reagents and detection of unusual or rare phenotypes or antibodies. Immunohematology. 2006;22:52-63 pubmed
    ..Many of the samples described in this review were sent to the reference laboratory at Gamma Biologicals, Inc., in Houston, Texas, which later became ImmucorGamma with sites in Norcross, Georgia, and Houston, Texas. ..
  20. Beris P, Picard V. Non-immune Hemolysis: Diagnostic Considerations. Semin Hematol. 2015;52:287-303 pubmed publisher
    ..An algorithm to be used in every new patient consulting for NIHA is proposed in the last part of this article. ..
  21. Budakov Z, Milosavljević Knezević N, Grujić J, Krga Milanović M. [Immunized pregnant woman with rare Rh fenotype--case report]. Med Pregl. 2013;66:81-5 pubmed
    ..Health care of pregnant women can be improved by following pregnancies according to the national antenatal testing algorithm and better teamwork of gynecologists and transfusions. ..
  22. Matthews J, Newton S. The Coombs test. Clin J Oncol Nurs. 2010;14:143-5 pubmed publisher
    The Coombs test, established as a clinical tool in 1945 by R.R. Coombs, usually is ordered when hemolytic anemia is suspected or if a transfusion reaction has occurred...
  23. Dussadee K, Taka O, Thedsawad A, Wanachiwanawin W. Incidence and risk factors of relapses in idiopathic autoimmune hemolytic anemia. J Med Assoc Thai. 2010;93 Suppl 1:S165-70 pubmed
    ..Short duration of maintenance and rapid tapering of corticosteroids and infections are possible risk factors of relapses/recurrent hemolysis in idiopathic AIHA. ..
  24. Garratty G. Immune hemolytic anemia caused by drugs. Expert Opin Drug Saf. 2012;11:635-42 pubmed publisher
    ..It is important to exclude DIIHA in such patients as the only treatment needed is to discontinue the drug. ..
  25. Ogawa K, Ito J, Fujimoto D, Morita M, Yoshizumi Y, Ariyoshi K, et al. Exacerbation of autoimmune hemolytic anemia induced by the first dose of programmed death-1 inhibitor pembrolizumab: a case report. Invest New Drugs. 2018;36:509-512 pubmed publisher
    ..The patient had chronic anemia with positive direct and indirect Coombs test prior to initiating pembrolizumab therapy at a nearby hospital...
  26. Madan A, Huntsinger K, Burgos A, Benitz W. Readmission for newborn jaundice: the value of the Coombs' test in predicting the need for phototherapy. Clin Pediatr (Phila). 2004;43:63-8 pubmed
    ..Infants with 2 or more risk factors for jaundice irrespective of the results of the DAT are at an increased risk for needing readmission for phototherapy. ..
  27. Salawu L, Durosinmi M. Autoimmune haemolytic anaemia: pattern of presentation and management outcome in a Nigerian population: a ten-year experience. Afr J Med Med Sci. 2002;31:97-100 pubmed
    ..It also shows that steroid therapy (prednisolone) is quite effective, especially, in idiopathic AHA, and that red cell transfusion could be useful in life-threatening anaemia. ..
  28. Weng Y, Chiu Y, Cheng S, Hsieh M. Risk assessment for adverse outcome in term and late preterm neonates with bilirubin values of 20 mg/dL or more. Am J Perinatol. 2011;28:405-12 pubmed publisher
    ..7, 95% CI = 25.8 to 3076.7). Adverse outcome was more common in infants with a positive direct Coombs test (OR = 4.5, 95% CI = 1.3 to 15.4)...
  29. Meng S, Yang Q, Han G, Yang J, Zhang H, Ye L, et al. [Clinical analysis of hemolytic-uremic syndrome associated with Streptococcus pneumoniae serotype 3 infection in a child]. Zhonghua Er Ke Za Zhi. 2013;51:535-9 pubmed
    ..Serotyping with simplified chessboard system was 3. The direct Coombs test was positive. Serum complement levels (C3 and C4) were depressed at 0.699 g/L, 0.064 g/L, respectively...
  30. Skaik Y, Overfield J. Detection of red cell antibodies: comparison of two low ionic strength diluents. Br J Biomed Sci. 2006;63:18-20 pubmed
    ..This study suggests that Inverclyde LISS provides better red cell alloantibody detection than does ID-CellStab, and this may be due to the higher ionic strength of ID-CellStab. ..
  31. Lambert J, Nydegger U. Geoepidemiology of autoimmune hemolytic anemia. Autoimmun Rev. 2010;9:A350-4 pubmed publisher and narrowing down the blood type subspecificities with diagnostic mAbs help to define the triggering autoantigen and to select well compatible donor RBC concentrates, which thus escape recognition by the autoantibodies. ..
  32. Aliskan H, Colakoglu S, Turunc T, Demiroglu Y, Yazic A, Arslan H. [Evaluation of diagnostic value of Brucellacapt test in brucellosis]. Mikrobiyol Bul. 2007;41:591-5 pubmed
    ..Although our data have pointed out the high performance of Brucellacapt test in brusellosis serodiagnosis, confirmation with further data carried on extensive and comprehensive study groups, are needed. ..
  33. Cash K, Brown T, Sausais L, Uehlinger J, Reed L. Severe delayed hemolytic transfusion reaction secondary to anti-At(a). Transfusion. 1999;39:834-7 pubmed
    ..Although anti-At(a) was previously described as being of uncertain clinical significance, this patient demonstrated the ability of the antibody to cause a severe delayed hemolytic transfusion reaction. ..
  34. Lauda Maillen M, Catroux M, Roy Peaud F, Souchaud Debouverie O, El Masmouhi B, Roblot P. [Diagnosis and management of acquired immune haemolytic anaemia excluding neoplasia. Adequacy with the current guidelines published in 2009]. Rev Med Interne. 2017;38:648-655 pubmed publisher
    ..The management of cold antibody AIHA complied with the guidelines. The positive predictive value of DATs in hospitalized population was of 14% (85/610). AIHA guidelines seem insufficiently applied in our center. ..
  35. Lee E, Redman M, Burgess G, Win N. Do patients with autoantibodies or clinically insignificant alloantibodies require an indirect antiglobulin test crossmatch?. Transfusion. 2007;47:1290-5 pubmed
    ..The IAT XM is both costly and time-consuming. It is proposed that for these study group patients, a reduction to an IS XM can be applied and can be beneficial. ..
  36. Miyamoto K, Kato T, Watanabe H, Miyamoto E, Suzuki S. A case of paraneoplastic syndrome accompanied by two types of cancer. J Neurol Neurosurg Psychiatry. 2002;72:408-9 pubmed
    ..It is recommended that plasmapheresis should be performed with caution in paraneoplastic syndrome when the origin of a tumour is obscure...
  37. Rigal D, Meyer F. [Autoimmune haemolytic anemia: diagnosis strategy and new treatments]. Transfus Clin Biol. 2011;18:277-85 pubmed publisher
    ..Nowdays, the second-line treatment includes rituximab or splenectomy. Sometimes, the anti-CD20 treatment could be proposed in first-line but some clinical trials are needed. ..
  38. Xu W, Li J, Miao K, Cao X, Liu Q, Fan L, et al. The negative prognostic significance of positive direct antiglobulin test in Chinese patients with chronic lymphocytic leukemia. Leuk Lymphoma. 2009;50:1482-7 pubmed publisher
    ..009). Five-year OS percentages of DAT-positivity and DAT-negative patients were 72.8% and 97.5%, respectively. It was showed that DAT status might be applied for the assessment of prognosis in patients with CLL. ..
  39. Wan S, Lin Y, Xia C, Zhao H, Xu J. Incipient Coombs' test negative autoimmune hemolytic anemia precedes non-Hodgkin's lymphoma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2012;20:97-9 pubmed
    ..Herein, this article reports a case of non-Hodgkin's lymphoma (NHL) preceded about 1.5 years by Coombs test negative AIHA. A woman aged 69 was diagnosed with HA based on the history and laboratory tests...
  40. Bing L, Fu R, Liu H, Wang H, Ruan E, Qu W, et al. [Application of bone marrow indirect Coombs test and its clinical significance in diagnosis of immuno-related pancytopenia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2012;20:505-9 pubmed
    This study was purposed to applicate the bone marrow indirect Coombs test and investigate its clinical significancies in diagnosis of immuno-related pancytopenia (IRP)...
  41. Sakai M, Shima M, Izumi Y, Shirahata A. [Acquired von Willebrand syndrome with autoimmune hemolytic anemia]. Rinsho Ketsueki. 2004;45:223-7 pubmed
    ..Throughout the course the patient contracted acute hepatitis A, became pregnant and gave birth, but there were no clear effects on the clinical phenotype of AvWS. ..
  42. Unal S, Kuskonmaz B, Balamtekin N, Baysoy G, Aytaç Elmas S, Orhan D, et al. Autoimmune hemolytic anemia and giant cell hepatitis: Report of three infants. Turk J Haematol. 2010;27:308-13 pubmed publisher
    ..Bu makalede bu nadir duruma sahip üç hastan?n ba?vuru özellikleri ve takibi sunulmu?tur. Ba?vuru an?ndaki serum ferritin de?erinin hastan?n prognozunu belirlemede kullan?labilece?i önerilmi?tir. ..
  43. Achkar R, Chiba A, Zampieri Filho J, Pestana J, Bordin J. Hemolytic anemia after kidney transplantation: a prospective analysis. Transfusion. 2011;51:2495-9 pubmed publisher
    ..5% of patients submitted to ABO-compatible nonidentical kidney transplants. ..
  44. Wheeler C, Calhoun L, Blackall D. Warm reactive autoantibodies: clinical and serologic correlations. Am J Clin Pathol. 2004;122:680-5 pubmed
    ..In patients with hemolysis, 21 (72%) of 29 had a DAT reactive for C3. These findings may be useful in determining the clinical significance of warm autoantibodies and the extent to which patients should be followed up for hemolysis. ..
  45. Heller T, Bélard S, Wallrauch C, Carretto E, Lissandrin R, Filice C, et al. Patterns of Hepatosplenic Brucella Abscesses on Cross-Sectional Imaging: A Review of Clinical and Imaging Features. Am J Trop Med Hyg. 2015;93:761-6 pubmed publisher
    ..Indirect Coombs test was positive in 96%...
  46. Broséus J, Visomblain B, Guy J, Maynadie M, Girodon F. Evaluation of mean sphered corpuscular volume for predicting hereditary spherocytosis. Int J Lab Hematol. 2010;32:519-23 pubmed publisher
    ..MSCV is a reliable automated parameter indicating possible HS. When a delta (MCV-MSCV) value is >9.6 fl, the FC test and the Coombs test are required in the differential diagnosis of HS and some AIHA.
  47. Marchand J, Gouezec H. [Blood transfusion practice]. Transfus Clin Biol. 2005;12:180-5 pubmed
    ..An update and a critical analysis of regulations currently in force are presented for each step as well as a description of the main adverse events. ..
  48. Blackall D. Warm-reactive autoantibodies in pediatric patients: clinical and serologic correlations. J Pediatr Hematol Oncol. 2007;29:792-6 pubmed
    ..These findings may be useful in predicting the clinical significance of warm-reactive autoantibodies in pediatric patients and allow for more efficient and effective follow-up care. ..
  49. Rovelli A, Corti P, Beretta C, Bovo G, Conter V, Mieli Vergani G. Alemtuzumab for giant cell hepatitis with autoimmune hemolytic anemia. J Pediatr Gastroenterol Nutr. 2007;45:596-9 pubmed
  50. Billoo S, Jamalvi S. Auto immune hemolytic anemia in a child precipitated by chicken pox. J Coll Physicians Surg Pak. 2008;18:319-20 pubmed publisher
    ..Auto Immune Hemolytic Anemia (AIHA) is a rare entity in children. We report a case of an adolescent girl with AIHA, which was precipitated by chicken pox. Clinical course over 3 years, till remission is described. ..
  51. Karahocagil M, Demirok A, Kilic A, Cinal A, Caksen H, Yasar T. Brucellosis and uveitis. Ann Ophthalmol (Skokie). 2008;40:48-50 pubmed
    ..In Case 2, a 12-year-old-girl diagnosis of left brucellosis uveitis was made. Both SAT and SAT/Coombs titers were positive at 1:1280. This report confirms that Brucellae organisms as a cause of uveitis...
  52. Meyer O, Hoffmann T, Aslan T, Ahrens N, Kiesewetter H, Salama A. Diclofenac-induced antibodies against RBCs and platelets: two case reports and a concise review. Transfusion. 2003;43:345-9 pubmed
    ..Based on our findings and those of other investigators, we believe that diclofenac leads to the production of antibodies against RBCs and/or platelets. ..
  53. Tasker S, Peters I, Papasouliotis K, Cue S, Willi B, Hofmann Lehmann R, et al. Description of outcomes of experimental infection with feline haemoplasmas: copy numbers, haematology, Coombs' testing and blood glucose concentrations. Vet Microbiol. 2009;139:323-32 pubmed publisher
    ..haemofelis infection, in contrast to 'Candidatus M. haemominutum' and 'Candidatus M. turicensis' infection, can result in a severe macrocytic anaemia and the development of cold and warm reactive erythrocyte-bound antibodies...