If you have been feeling very fatigued, have shortness of breath, cold hands and feet and very pale skin, you may have an insufficient amount of red blood cells. This condition is called anemia, and there are many causes. If it is confirmed that you have a low red blood cell count, the Coombs’ test is one of the blood tests that your doctor may order to help find out what kind of anemia you have.
The Coombs’ test checks the blood to see if it contains certain antibodies. Antibodies are proteins that your immune system makes when it detects that something may be harmful to your health and needs to be destroyed by the immune cells. If the immune system’s detection is wrong, it will make antibodies that do not destroy what is harmful. This can cause many kinds of health problems.
The Coombs’ test will help your doctor determine if you have antibodies in your bloodstream, causing your immune system to attack and destroy your own red blood cells. If your red blood cells are being destroyed, this can result in a condition called hemolytic anemia.
There are two types of Coombs’ test; the direct Coombs’ test and the indirect Coombs’ test. The direct test is more common and checks for antibodies that are attached to the surface of your red blood cells. The indirect test checks for unattached antibodies that are floating in the bloodstream and is also administered to determine if there was a potential bad reaction to a blood transfusion.
A sample of your blood will be needed to perform the test. The blood is tested with compounds that will react with antibodies in your blood.
The blood sample is obtained through “venipuncture,” where a needle is inserted into a vein in your arm or hand. The needle draws a small amount of blood into tubing, and the sample is stored in a test tube.
Often this test is done on infants who may have antibodies in their blood because their mother has a different blood type. To do this test in an infant, the skin is pricked with a small sharp needle called a lancet, usually on the heel of the foot. Blood is collected into a small glass tube, on a glass slide, or on a test strip.
No special preparation is necessary. Your doctor will have you drink a normal amount of water before going to the laboratory or collection site.
You may have to stop taking certain medications before the test is performed, but only if your doctor tells you to do this.
When the blood is collected, you may feel moderate pain or a mild pinching sensation, though this is usually for a very short duration and very slight. After the needle is removed, you may feel a throbbing sensation, and you will be instructed to apply pressure to the site the needle entered your skin. A bandage will be applied, and it will need to remain in place typically for 10 to 20 minutes. You should avoid using that arm for heavy lifting for the rest of the day.
Very rare risks include:
- lightheadedness or fainting
- hematoma—a bruise in which blood accumulates under the skin
- infection—usually prevented by the skin being cleaned before the needle is inserted
- excessive bleeding—(Bleeding for a long period after the test may indicate a more serious bleeding condition and should be reported to your doctor.)
Results are considered normal if there is no clumping of red blood cells. The clumping is called agglutination and means that there are no antibodies attached to red blood cells present in your blood, and that this is not the cause of any anemia that may be present. This is “normal” because most people do not have antibodies attached to red blood cells.
If there is clumping of the red blood cells during the test, then it is an abnormal result. Clumping (agglutination) of your blood cells during a direct Coombs’ test means that you have antibodies on the red blood cells and that you may have a condition that causes the destruction of red blood cells by your immune system (hemolysis). The conditions that may cause you to have antibodies on red blood cells are:
- autoimmune hemolytic anemia (your immune system reacts to your red blood cells)
- drug toxicity where you develop antibodies to your red blood cells: Drugs that can sometimes cause this include cephalosporins (an antibiotic), levodopa (for Parkinson’s disease), dapsone (antibacterial), nitrofurantoin (antibiotic), NSAIDS such as ibuprofen, and quinidine (heart medication).
- transfusion reaction where your immune system attacks donated blood
- different blood types between mother and infant (erythroblastosis fetalis)
- chronic lymphocytic leukemia and some other leukemias
- lupus (systemic lupus erythematosus), an autoimmune disease
- infection with mycoplasma (a type of bacteria that many antibiotics can’t kill)
Sometimes, especially in older patients, a Coombs’ Test will have an abnormal result even without any other disease or risk factors.
An abnormal result to an indirect Coombs’ test means you have antibodies circulating in your bloodstream that could cause your immune system to react to any red blood cells that are considered foreign to the body, as may be present during a blood transfusion. Depending on your age and circumstances, this could mean a mother and infant have different blood types (erythroblastosis fetalis); an incompatible blood match for a blood transfusion; or hemolytic anemia due to autoimmune reaction or drug toxicity.
Infants with erythroblastosis fetalis may have very high levels of bilirubin in their blood, which leads to jaundice. This reaction occurs when the infant and mother have different blood types (Rh factor + or -, or ABO type differences), and the mother’s immune system attacks the baby’s blood during labor. This condition must be watched carefully because it can result in death of the mother and child. Often during prenatal care, a mother is given an indirect Coombs’ test to check for antibodies before labor.