Agglutination of blood cardioplegia by cold reacting autoantibodies

Normothermic Cardiac Surgery with Warm Blood Cardioplegia in Patient with Cold Agglutinins

“…Cold agglutinin disease (cold antibody disease) is caused by autoantibodies that react at decreased blood temperature and produce agglutination or hemolysis of red blood cells [1,2,3]. The causes of this situation include infections (especially mycoplasmal pneumonias or infectious mononucleosis), lymphoproliferative disorders, and idiopathic diseases (about half ofcases).…”

“…There are no widely accepted definitions of high and low titers; however, Lee et al [7] suggested that titers less than 1:32 are low, and those greater than 1:128 are high. Holman et al [2] reported a patient who developed intracoronary agglutination of the blood cardioplegia solution during coronary artery bypass surgery. The cold agglutinin had an agglutination titer of 256 at 4℃.…”

“…The cold agglutinin had an agglutination titer of 256 at 4℃. During surgery, the heart was arrested using a 4℃ blood cardioplegia solution, and agglutinated blood was found when the coronary artery was incised [2]. …”

In Vitro Agglutination in Cardioplegic Solution Prepared from Lactated Ringer

“…Bu ender görülen komplikasyonlar içerisinde en sık görülen komplikasyon ise soğuk reaksiyonlu otoantikorların neden olduğu aglütünasyondur (1,2) . Bu olgularda intrakoroner aglütinasyon koroner arterlerde mikro ya da makro embolizasyonlara neden olmakta ve yaşamı tehdit eden durumlar oluşmaktadır.…”

“…Biz de bu olgumuzda klinik olarak sessiz soğuk antikorların kardiyak arrestin devamını sağlamak için hazırlanan kan kardiyoplejisinde aglütinasyona neden olabileceğini düşünmekteyiz. Bu hastada aglütine olmuş kan kardiyoplejisi hastaya verilmiş olsaydı, koroner arterlere makroemboliler giderek iskemi oluşturabilirdi (2) . Bu nedenle kardioplejik solüsyon değişimlerinde anestezist daha dikkatli davranılmalıdır.…”