The Effect of Hypothermic Cardiopulmonary Bypass on Patients with Low-Titer, Nonspecific Cold Agglutinins

Moore, Roger A.; Geller, E.; Mathews, Elaine S.; Botros, Samir B.; Jose, Arachelle B.; Clark, Donald L.

doi:10.1016/s0003-4975(10)60331-1

Cited by 32 publications

(21 citation statements)

References 11 publications

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“…Higher cold agglutinin titers and higher thermal amplitude are more clinically significant than low titers and low thermal amplitude. Indeed, several researchers have stated that patients with low-titer, low thermal amplitude antibodies may undergo operation without any change in the routine management plan [6]. During a cardiac operation, the cardioplegia solution at very low temperature is infused via coronary artery for myocardial protection.…”

Section: Discussionmentioning

confidence: 99%

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

Cho

Kim

Kwak

2014

Korean J Thorac Cardiovasc Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Cho

Kim

Kwak

2014

Korean J Thorac Cardiovasc Surg

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“…14 Increased cellular protection occurs due to the decreased complement activity at colder temperatures, 7 and that upon rewarming, the reversibility of the Ab± antigen complex occurs. Hemolysis occurs in patients with CA disease when the Ab± Ag complex allows the binding of C3 component of the complement system to the RBC antigenic site.…”

Section: Discussionmentioning

confidence: 99%

“…Hemolysis is initially avoided due to the C3b inactivator, but once complement overcomes the C3b inhibitory threshold, C3b is unable to be converted to the inactive C3d, resulting in C3b that is able to induce complement fixation, which ultimately results in RBC lysis. 7,12 Upon rewarming, the Ab is released from the RBC Ag, deaggregation occurs, and viable RBCs that avoided destruction from incomplete complement activity are now coated with C3d. The C3d-coated cells are somewhat protected from lysis and agglutination upon recooling.…”

Section: Discussionmentioning

confidence: 99%

Cold agglutinins complicating repair of aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest: case report and review

2002

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Cold agglutinins (CAs) are autoantibodies that react reversibly with red blood cells (RBCs) at temperatures of, or below, the thermal amplitude for agglutination. This results in increased blood viscosity and sludging of RBC, and may impair perfusion to various organ systems. Although this phenomenon appears rarely in the clinical arena, the incidence of CA is increased substantially in cardiac surgery due to the routine use of hypothermia for organ preservation and systemic metabolic reduction. Once activated, CA are associated with microvascular occlusion, hemolysis, complement fixation, renal and hepatic insufficiency, cerebral insult, and myocardial infarction. Complications from CA may be minimized with appropriate screening, detection, and management in the perioperative period. A prototypical case is described, and pertinent issues regarding CA are reviewed.

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“…Therefore, cold agglutinins of low thermal amplitude can be missed in pretransfusion testing using recently drawn specimens 1 . Haemolysis in patients with cold agglutinin antibody is produced when the antibody-antigen interaction induced by cooling leads to a combination of the C3 component of the complement system with the red blood cell antigenic site 3 . Red blood cell lysis occurs as the sequence progresses uninhibited (as is shown in the …”

Section: Discussionmentioning

confidence: 99%

“…This serves as a major protective feature for patients with the classic form of cold agglutinin disease 3 .…”

Section: Rbc Lysismentioning

confidence: 99%

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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The Effect of Hypothermic Cardiopulmonary Bypass on Patients with Low-Titer, Nonspecific Cold Agglutinins

Cited by 32 publications

References 11 publications

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

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

Cold agglutinins complicating repair of aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest: case report and review

Cold agglutination in open heart surgery

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