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

Abstract

Cold agglutinins are predominately immunoglobulin M autoantibodies that react at cold temperatures with surface antigens on the red blood cell. This can lead to hemagglutination at low temperatures, followed by complement fixation and subsequent hemolysis on rewarming. Development of hemagglutination or hemolysis in patients with cold agglutinins is a risk of cardiac surgery under hypothermia. In addition, there is the potential for intracoronary hemagglutination with inadequate distribution of cardioplegic solutions, thrombosis, embolism, ischemia, or infarction. We report a patient with incidentally detected cold agglutinin who underwent normothermic cardiac surgery with warm blood cardioplegia.

Deep Hypothermic Circulatory Arrest for Emergency Repair of Type A Aortic Dissection in a Patient with Cold Agglutinins

“…Management strategies include reduction of antibody levels through plasma exchange, administration of steroid, azathioprine, cyclophosphamide, or rituximab, in an effort to mitigate the likelihood of clinical significance (3,4). Other strategies during surgical interventions include avoiding hypothermia, temperatures above the TA, warm blood cardioplegia, moderate hypothermic CPB with systemic circulatory arrest (4,6,(14)(15)(16)(17). If agglutination occurs intraoperatively, warming the core temperature until resolution of agglutinins and utilizing warm retrograde myocardial washout are possible options (4).…”