Cold agglutinins in a patient undergoing normothermic cardiac operation with warm cardioplegia

Abstract

Cold agglutinins are autoantibodies that agglutinate red blood cells at low temperatures, leading to haemagglutination and haemolysis. They are generally of no clinical significance. However, when people with cold agglutinins undergo cardiac operation with hypothermia and cold cardioplegia, they can experience complications. Thus, different perioperative management is required for such patients. We describe a 74-year-old man with cold agglutinins incidentally detected on the preoperative screening test. He had never experienced any complications or developed a haematological disease. Since cold agglutinins were incidentally detected on the preoperative test, a special strategy was used to manage the temperature of cardiopulmonary bypass (CPB) and cardioplegia. He successfully underwent normothermic cardiac operation with warm cardioplegia. A continuous retrograde hyperkalaemic infusion and intermittent antegrade infusion of warm cardioplegia with normothermic CPB is one of the best methods to avoid hypothermia and excessive activity and metabolism of the heart, and to provide a suitable operative field.

Total arch replacement for an aortic arch aneurysm with cold agglutinin disease after rituximab and plasmapheresis

“…IgM autoantibodies are present in blood vessels in approximately 95% of cases, and they have been reported to reduce agglutinin titers by up to 80% with plasmapheresis. Although it has been reported that the thermal amplitude is more important than the titer for predicting the likelihood of complications [ 14 ], the thermal altitude remained the same as that before the administration of rituximab and plasmapheresis; however, the titer decreased from 1:4 at 28 °C to 1:2 at 28 °C only after plasmapheresis (Fig. 4 ).…”

Total Arch Replacement for Aortic Arch Aneurysm with Cold Agglutinin Disease after Rituximab and Plasmapheresis

“…IgM autoantibodies are estimated to be present in blood vessels by 95% of cases and have been reported to reduce agglutinin titers by up to 80% each time with plasmapheresis. Although it is reported that thermal amplitude is more important than the titer in predicting the likelihood of complications [13],the thermal altitude remained the same as that before administration of rituximab and plasmapheresis; however, the titer decreased from 28 ℃(2+) to 28℃ 1 + only after plasmapheresis (Figure 3).…”