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Heterophil agglutination tests
Heterophil agglutination tests

Heterophil agglutination tests
Definition:
The Heterophil agglutination test is a means of detecting two antibodies in the blood that indicate infection with the Epstein-Barr virus (EBV).
Alternative Names:
Paul-Bunnell test; Forssman antibody test
How the test is performed:

Adult or child:
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band) or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to distend (fill with blood).

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

Infant or young child:
A finger is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

The sample is then taken to the laboratory and the serum separated from the cells. Part of the serum is mixed with sheep red blood cells and part with horse red blood cells.
How to prepare for the test:
Adults:
No special preparation is necessary.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

How the test will feel:
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the test is performed:
Your health care provider may use this test to aid in the diagnosis of infectious mononucleosis and illness caused by (EBV).
Normal Values:
The Paul-Bunnell and Forssman antibodies react with sheep and horse red blood cells causing clumping. No clumping (agglutination) with a titer lower than 1:56 is the normal result.
What abnormal results mean:
If the titer rises to around 1:220 in the 3rd or 4th week of infection, then gradually decreases in the following 4 weeks infectious mononucleosis may be diagnosed.
What the risks are:
Risks associated with venipuncture are slight:
  • Excessive bleeding
  • Fainting or feeling lightheaded
  • Hematoma (blood accumulating under the skin)
  • Infection (a minimal risk any time the skin is broken)
  • Multiple punctures to locate veins
Special considerations:
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Review Date: 7/24/2001
Reviewed By: Joann Habermann M.D., Deputy County Medical Examiner, Middlesex, NJ. Review provided by VeriMed Healthcare Network.

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