The molecular basis for cold agglutination: effect of receptor density upon thermal amplitude of a cold agglutinin.

Cold agglutinin MKV is a Waldenström macroglobulin that agglutinates human erythrocytes in the cold by binding $\text{N}$-acetylneuraminosyl-containing carbohydrate chains on their surfaces. Neuraminidase-treated cells are not agglutinated but their reactivity can be restored by allowing them to adsorb hematoside (NeuNAcα2-3Galβ1-4Glcβ1-ceramide). When between 7 × 10⁴ and 10⁶ molecules are adsorbed per cell, the cells are agglutinated at 0° but not at 37°. When over 10⁶ molecules of hematoside are adsorbed, they are agglutinated at both 0° and 37°. The density of receptors on the erythrocyte surface can thus influence the thermal amplitude of cold agglutinins.