Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Barbara, David W.; Mauermann, William J.; Neal, James R.; Abel, Martin; Schaff, Hartzell V.; Winters, Jeffrey L.

doi:10.1016/j.jtcvs.2013.03.009

Cited by 51 publications

(60 citation statements)

References 26 publications

(62 reference statements)

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“…Cold agglutinins are autoantibodies that agglutinate red blood cells at low temperatures, leading to haemagglutination and haemolysis 1–11. They are generally of no clinical significance 1–3 5 6 8 10 11.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…They are generally of no clinical significance 1–3 5 6 8 10 11. However, when people who have cold agglutinins in their blood undergo cardiac operation under hypothermia and cold cardioplegia, they can experience complications 1 2 4 6 7 10 11. The reported incidence of cold agglutinins among screened cardiac surgical patients is low but not too rare (approximately 0.8%–4%4 6 7), and different perioperative management is required for such patients.…”

Section: Introductionmentioning

confidence: 99%

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

Ogawa

2017

BMJ Case Reports

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ogawa

2017

BMJ Case Reports

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“…Appropriate screening with CA titers and thermal threshold has been recommended for patients undergoing cardiac surgery who are suspected to be at risk. 1 However, the incidence of cold agglutination syndrome was found to be 0.3% among 14,900 patients undergoing cardiac surgery with CPB who were all screened with CA titers. Jain et al reported that the surgeons altered cardiopulmonary bypass management by avoiding hypothermia in only one-third of the identified patients.…”

Section: Discussionmentioning

confidence: 99%

“…1 Because cardiopulmonary bypass (CPB) can involve deliberate hypothermia of the systemic and coronary circulations, the adverse sequelae of CA have been feared and reported under such conditions. The authors present a case of successful perioperative management of a patient in whom CA activation was diagnosed after the initiation of CPB for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR).…”

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Cardiopulmonary Bypass Management Complicated by a Stenotic Coronary Sinus and Cold Agglutinins

Yalamuri

Heath

McCartney

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Anesthesiology and Veteran Affairs Anesthesiology, Durham, NC COLD AGGLUTININS (CA) are circulating autoantibodies that reversibly bind red blood cells, causing agglutination and increased blood viscosity. 1 Because cardiopulmonary bypass (CPB) can involve deliberate hypothermia of the systemic and coronary circulations, the adverse sequelae of CA have been feared and reported under such conditions. The authors present a case of successful perioperative management of a patient in whom CA activation was diagnosed after the initiation of CPB for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). This patient also had a stenotic coronary sinus (CS), adding to the complexity of management of CPB and administration of cardioplegia. Patient permission was obtained for the publication of this case report. DescriptionA 67-year-old man with moderate-to-severe aortic stenosis (mean gradient 36 mm/s) and multivessel coronary artery disease presented for CABG and AVR. Preoperative workup revealed preserved biventricular function with moderate left ventricular hypertrophy, 80% stenosis of the proximal left main coronary artery, and 99% stenosis of the proximal right coronary artery. He previously underwent an uneventful anesthetic for carotid artery bypass in preparation for his cardiac surgery. After placement of a radial artery catheter for pressure monitoring, anesthesia was induced with midazolam, fentanyl, lidocaine, propofol, and rocuronium. Aminocaproic acid was used for antifibrinolysis, with a 10-g bolus dose followed by a 5-g dose infused over 5 hours. Vein graft harvest and central aortic arterial and bicaval venous cannulation were uneventful.After an activated coagulation time of 4400 seconds was achieved, CPB was initiated. Because of CS stenosis (confirmed by the small ostial opening on transesophageal echocardiography [TEE]), a retrograde catheter could not be placed even under direct vision with bicaval cannulation (performed for better visualization of the coronary sinus ostia after the initial inability to cannulate). 2 Systemic perfusion was maintained at 361C inflow temperature, and the nasopharyngeal temperature approached a nadir of 351C.Before administration of cardioplegia, crystalloid cardioplegic solution (Plegisol; Hospira, Lake Forest, IL) was mixed with blood (4:1 ratio) and cooled to 4 1 C with a BCD Vanguard heat exchanger (Sorin, Milan, Italy). Within the tubing the blood separated rapidly, and large clumps of red cells were seen settling through the plasma in the tubing (Fig 1, Video 1). Because of the high index of suspicion, no cardioplegia was given, pending laboratory confirmation. A sample of blood was sent to the laboratory immediately for a rapid test for cold agglutinins. Specific cold agglutinin testing was not available immediately; however, a small amount of blood was cooled to 41C, and 4 þagglutination was observed. This information was relayed to the operating room so that the surgical plan could be altered. Subsequent testing revealed 2 þ agglutination a...

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Cardiopulmonary Bypass

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Cited by 51 publications

References 26 publications

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

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

Cardiopulmonary Bypass Management Complicated by a Stenotic Coronary Sinus and Cold Agglutinins

Cardiopulmonary Bypass

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