Cardiopulmonary bypass and cold agglutinin

Paccagnella, Agostino; Simini, G.; Nieri, A; U, Da Col; Frugoni, C; Valfré, Carlo

doi:10.1016/s0022-5223(19)35780-0

Cited by 11 publications

(1 citation statement)

References 4 publications

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“…High-volume plasmapharesis has been utilized to achieve an 8-fold to 10-fold reduction in cold agglutinin titers. 35 –37 However, there are associated risks of infection and altered hemostasis with this technique. It is clear that exchange transfusion is not necessary, provided that the patient’s core temperature is maintained several degrees above the antibody’s thermal amplitude, 38 and therefore should be reserved for those patients with high titers of antibodies requiring deep hypothermic arrest.…”

Section: Cold Agglutinin Diseasementioning

confidence: 99%

Anesthetic and Cardiopulmonary Bypass Considerations for Cardiac Surgery in Unique Pediatric Patient Populations: Sickle Cell Disease and Cold Agglutinin Disease

Daaboul

Yuki

Wesley

et al. 2011

World J Pediatr Congenit Heart Surg

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Physiological disturbances induced by cardiopulmonary bypass (CPB) and hypothermia during cardiac surgery are particularly pronounced in certain unique patient populations, such as patients with sickle cell disease (SCD) and cold agglutinin disease. Red blood cells containing hemoglobin S (HbS) are at increased risk of sickling under conditions encountered during cardiac surgery, leading to SCD-related complications such as vaso-occlusive events. While a target level of HbS has not been determined for patients with SCD undergoing CPB, a safe practice includes increasing the Hb level to 10 g/dL and reducing the proportion of HbS to approximately 30%. This can be accomplished through simple or exchange transfusion prior to surgery or via the modification of the CPB circuit prime. There is no clear consensus on the formulation or the delivery temperature of the cardioplegia solution necessary to prevent sickling and microvascular occlusion. The presence of cold agglutinins is another entity requiring extra vigilance for the conduct of CPB, where hypothermia can lead to activation of cold agglutinins inducing massive hemagglutination, hemolysis, microvascular thrombosis, and possibly intracoronary thrombosis. Determination of thermal amplitude is important to provide a safe reference range of temperature during surgery. High-volume plasmapheresis may be warranted to reduce cold agglutinin titers. Both warm blood cardioplegia and cold crystalloid cardioplegia above the thermal amplitude have been utilized with success.

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Section: Cold Agglutinin Diseasementioning

confidence: 99%

Anesthetic and Cardiopulmonary Bypass Considerations for Cardiac Surgery in Unique Pediatric Patient Populations: Sickle Cell Disease and Cold Agglutinin Disease

Daaboul

Yuki

Wesley

et al. 2011

World J Pediatr Congenit Heart Surg

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Cold agglutination in open heart surgery

Muthialu

Manickavasakam

Singh

et al. 2002

Indian J Thorac Cardiovasc Surg

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IntroductionCold agglutinins are incomplete antibodies present in various clinical conditions. They bind with erythrocytes in low temperature and cause selective aggregation thereby enhancing the possibility of haemolysis. Preoperative detection of cold antibody can help in planning of open heart surgery as in our patient where the mitral valve was replaced under normothermia. Case ReportA 40 -year-old female patient presented to us with class III symptoms of dyspnoea on exertion and palpitation for 2 years. Evaluation revealed tight mitral stenosis with moderate mitral regurgitation. She was in atrial fibrillation. After complete evaluation she was planned for elective mitral valve replacement. Her baseline haematological investigations were within normal limits and her blood group was O positive. The blood sent for cross matching was found to be incompatible with all samples tested. Spontaneous clumping was also seen against normal saline suggesting the possibility of the presence of cold agglutinin. Based on this, studies for spontaneous clumping at various temperatures were carried out. Clumps were seen between 4 0 C and 25 0 C but not at 37 0 C. After serial and complete washing of the sample with normal saline, clumping was not noted even at low temperature. On assay, the cold agglutinin titre was found to be 1:128. Further haematological tests in the form of assays for haemolysis were carried out which were negative. Coombs indirect antigen was weakly positive. Bone marrow examination was normal. Antibody assays to rule out systemic lupus

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