Agglutination is the process by which particulate antigens such as cells aggregate to form larger

complexes when a specific antibody is present.

If an agglutination reaction involves RBCs, then it is called hemagglutination. The best example of this
occurs in ABO blood group typing of human RBCs, one of the world’s most frequently used
immunoassay

Whereas precipitation reactions involve soluble antigens, agglutination is the visible aggregation of
particles caused by combination with specific antibody. Antibodies that produce such reactions are often
called agglutinins. Because this reaction takes place on the surface of the particle, antigen must be
exposed and able to bind with antibody. Types of particles participating in such reactions include
erythrocytes, bacterial cells, and inert carriers such as latex particles

agglutinogen  Any substance that acts as an antigen to stimulate production of specific agglutinin.
Supplement. Agglutinogens in the blood are proteins existing on the surface of every red blood cell in
the body.

When immunoglobulin levels in the blood are sufficiently high, they may cause the formation of
rouleaux, stacklike formations of red blood cells (RBCs) that can be seen on examination of a peripheral
blood smear.

In a mixed field reaction, two different ABO groups are present in the same
sample, causing discordant ABO typing. The front and back type results are
not as predicted.
It occurs when patient sera react with all red blood cells (RBCs) tested, that is, with both
screening and identification panel cells used in first approach. Panagglutinin. An antibody that
reacts against all reagent cells in an antibody panel, rather than against one or more specific
cells. Panagglutinins are most commonly autoantibodies, but may also be alloantibodies
targeted against high-frequency red cell antigens (antigens present on just about everyone
else's RBCs).

Polyagglutination is the term applied to red blood cells (RBCs) that are agglutinated by almost
all samples of human sera from adults but not by autologous serum or sera of newborns. 

Nonspecific agglutination of red cells in the presence of human serum, not related to blood
group specificity. This occurs most often as a consequence of infections, when bacterial
enzymes actually strip off parts of antigens normally present of the surface of the red cell.

In the case of antibody excess, the prozone phenomenon occurs, in which antigen combines with only
one or two antibody molecules and no cross-linkages are formed. Usually only one site on an antibody
molecule is used and many free antibody molecules remain in solution.
At the other side of the zone, where there is antigen excess, the postzone phenomenon occurs in which
small aggregates are surrounded by excess antigen. Again, no lattice network is formed. In this case,
every available antibody site is bound to a single antigen and no cross-links are formed.

Beck, M. L. (2000). Red blood cell polyagglutination: Clinical aspects. Seminars in Hematology, 37(2),

186-196. https://doi.org/10.1016/s0037-1963(00)90043-x

Gonsorcik, V. (2020). ABO grouping: Overview, clinical indications/Applications, test performance.

Diseases & Conditions - Medscape Reference. https://emedicine.medscape.com/article/1731198-

overview#a3

Stevens, C. D., & Miller, L. E. (2016). Clinical immunology and serology: A laboratory

perspective (4th ed.).