Cold Antibody and Persistent Intravascular Hemolysis after Surgery under Hypothermia

Wertlake, Paul T.; McGinniss, Mary H.; Schmidt, P

doi:10.1111/j.1537-2995.1969.tb04919.x

Cited by 29 publications

(11 citation statements)

References 10 publications

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“…Prolonged postoperative hemolysis has been reported in a patient with CA undergoing cardiac surgery with hypothermia. 11 This is a rare complication that we did not note in our practice and has not been shown in other series. 9,12,14 In the 11 patients requiring postoperative vasoactive medications, the requirements were consistent with preoperative myocardial function and type of operation.…”

Section: Discussionmentioning

confidence: 46%

“…Laboratory testing relevant to CHAD includes those related to hemolysis (hemoglobin, direct antiglobulin test, lactate dehydrogenase, haptoglobin, free plasma hemoglobin, and bilirubin) and others related to the quantification and activity of CA antibodies (CA antibody titer and thermal amplitude, respectively). 3,9,11 The method of CA titer quantification at the Mayo Clinic College of Medicine is detailed in Appendix 4. There is potential for inaccuracy and significant interoperator variability in performing antibody titers because of the subjective nature of the end point of the reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic hypothermia and cold cardioplegia may result in blood reaching temperatures that can cause agglutination and hemolysis. 9,10 Hemolytic anemia 11 and myocardial dysfunction 12 have been attributed to CA in patients undergoing hypothermic CPB, whereas dysfunction of other end organs secondary to CA is a hypothetical concern. 3,9 Experience involving patients with CA and CHAD undergoing cardiac surgery requiring CPB consists of case reports and small series 9,12 of less than 20 cases that do not distinguish patients with CA from those with CHAD and case reports of patients with CA and CHAD.…”

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confidence: 99%

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Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Barbara¹,

Mauermann²,

Neal

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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All patients with CA/cold hemagglutinin disease at the Mayo Clinic College of Medicine safely underwent cardiac surgery without major adverse morbidity or mortality. Patients with CA but without evidence of cold hemagglutinin disease can safely undergo normothermic cardiopulmonary bypass at 37°C and warm cardioplegia without further testing. Patients with cold hemagglutinin disease should undergo laboratory testing including CA titers and thermal amplitude and hematology consultation before cardiac surgery.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Barbara¹,

Mauermann²,

Neal

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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“…Potential complications include hemolytic anemia, microvascular occlusion, decreased organ perfusion, and renal failure. [6][7][8] Although there is extensive literature on the management of CAs (both benign and malignant) during CPB, relatively few reports highlight the consequences of CHAD in off-pump cardiac surgery. 2,7,[9][10][11] The dangers of hypothermia are present even in offpump procedures, because of radiant heat loss from sternotomy in a cold operating environment.…”

Section: Discussionmentioning

confidence: 99%

Use of an Intravascular Warming Catheter during Off-Pump Coronary Artery Bypass Surgery in a Patient with Severe Cold Hemagglutinin Disease

Tholpady¹,

Baker²,

Reul³

et al. 2016

Texas Heart Institute Journal

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C old hemagglutinin disease (CHAD) is a type of autoimmune hemolytic anemia that results in the harmful presence of cold autoantibodies against red blood cells (RBCs). The cold agglutinins (CAs) found in patients with CHAD have a broad thermal amplitude that enables them to activate in exposed parts of the body, such as the peripheral circulatory system. The disease can be especially troublesome-to the point of causing serious morbidity-in patients who undergo perioperative hypothermia. In this case study, we report the novel use of an intravascular warming device to maintain normothermia and prevent RBC agglutination during off-pump coronary artery bypass (OPCAB) surgery. Case ReportIn June 2011, a 77-year-old man with long-standing hypertension was evaluated for dyspnea on exertion, of 6 months' duration. Results from prior studies, including a sleep study, computed tomographic scan, and ultrasonography, were all noncontributory. The results of a nuclear stress test were normal, but coronary angiography revealed non-stentable coronary artery disease in the left anterior descending coronary artery (LAD). The patient was then referred to our institution for possible coronary artery bypass grafting.The patient's medical history included, at the age of 63 years, hemolysis and chronic anemia that had led to a diagnosis of CHAD. In the past, he had experienced-after exposure to cold-black discoloration of his fingertips, toes, nose, and ears, which symptoms had been followed by dark urine and jaundice. As a result, he took special precautions to dress warmly and avoided going outside during winter months. In addition, hemolysis in association with a previous prostatectomy had necessitated 2 RBC transfusions.The patient's laboratory values on admission to our institution were as follows: hemoglobin, 9.8 g/dL; reticulocyte count, 4.3% (normal range, 0.5%-1.5%); total bilirubin, 1.4 mg/dL (normal range, 0.3-1.1 mg/dL); direct bilirubin, 0.4 mg/dL (normal range, 0.1-0.4 mg/dL); lactate dehydrogenase, 382 U/L (normal range, 107-206 U/L); and haptoglobin, <8 mg/dL (normal range, 14-258 mg/dL).In his initial blood-bank examination, antibody screening by gel methodology was negative. However, a direct antiglobulin test (DAT) was scored as 4+ agglutination for Case ReportsAshok Tholpady, MD

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“…7 Additionally, surface cooling procedures are complicated by the phenomenon of rewarming afterdrop 8 and may cause cerebral swelling during the rewarming period. 9 Equally limiting have been the deleterious side effects associated with total body hypothermia, including cardiac arrhythmias, 10 -12 coagulopathy, 13,14 hemolysis, 15 renal and hepatic dysfunction, 16,17 and immunosuppression. 18 -20 To avoid the systemic complications of total body cooling, investigators have attempted selective cerebral hypothermia.…”

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confidence: 99%

Ultrarapid, Convection-Enhanced Intravascular Hypothermia

Mack

Huang

Winfree

et al. 2003

Stroke

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Background and Purpose-Hypothermia has been shown to be neuroprotective in a variety of clinical settings.Unfortunately, poor delivery techniques and insufficient data in appropriate preclinical models have hampered its development in human stroke. To address these limitations, we have devised a 10F intravascular catheter capable of rapid systemic cooling of nonhuman primates. Methods-Placed in the inferior vena cava via a transfemoral approach, the catheter was used to induce mild systemic hypothermia 3 hours after the onset of hemispheric stroke in baboons. Results-Cooling was achieved at a rate of 6.3Ϯ0.8°C/h. Target brain temperatures (32.2Ϯ0.2°C) were reached at the same time (47.7Ϯ6.32 minutes) as target esophageal temperatures (32.0Ϯ0.0°C). Hypothermia was maintained for 6 hours in all animals. Animals did not experience the infections, coagulopathy, or cerebral edema commonly seen with surface cooling methods in human stroke. Conclusions-These data suggest that a brief episode of mild core hypothermia instituted at a clinically relevant time point can be achieved in primate stroke and that our intravascular cooling technique provides safe, rapid, and reproducible hypothermia. (Stroke.

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Cold Antibody and Persistent Intravascular Hemolysis after Surgery under Hypothermia

Cited by 29 publications

References 10 publications

Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Use of an Intravascular Warming Catheter during Off-Pump Coronary Artery Bypass Surgery in a Patient with Severe Cold Hemagglutinin Disease

Ultrarapid, Convection-Enhanced Intravascular Hypothermia

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