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Cardiopulmonary bypass in patients with cold agglutinins
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8/11/2016 at 11:29:36 PM GMT
Posts: 9
Cardiopulmonary bypass in patients with cold agglutinins

From a transfusion service:

 

How to manage patients with cold agglutinins undergoing cardiac surgery (hypothermic cardioplegia)?

 

Review of the literature indicates all options for managing a patient with cold autoantibodies undergoing cardiac surgery and hypothermic bypass. Some indicate need to avoid hypothermic cardioplegia whereas a majority would proceed without any modifications (including hypothermic cardioplegia). There are no set protocols that I could identify on how to deal with such patients. I am seeking advice from practitioners at large hospitals (especially those that deal with lots of cardiac bypass surgeries) to see their experience and how they manage patients who show presence of cold antibodies. Appreciate your responses.



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8/24/2016 at 10:39:35 PM GMT
Posts: 9
From the CBBS Editors:

Several of us at institutions performing cardiac bypass procedures note that our transfusion services do not screen for cold autoantibodies in patients pre-operatively. In one study, even when screening was performed by the transfusion service, most of the time the surgical team did not modify cardiopulmonary bypass in response to the presence of a cold autoantibody (1). In this series, the rate of adverse events was low in patients with cold agglutinins identified by screening, whether or not cardiac bypass/cold cardioplegia was modified.

If a cold agglutinin causes actual clumping in the cardiopulmonary bypass circuit, the temperature of the cardioplegia can be adjusted. In the rare patient with known symptomatic cold agglutinin disease or who has a procedure aborted due cold-associated clumping, further investigation with thermal amplitude testing and cold agglutinin titers may be useful to confirm the antibody’s clinical significance (2).

1. Jain et al. Seek and you shall find – but then what do you do? Cold agglutinin screening before cardiac surgery. Transfusion Med Reviews 2013 (http://dx.doi.org/10.1016/j.tmrv.2012.12.001).
2. Barbara et al. Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass. J. Thoracic and Cardiovasc Surgery 2013 (http://dx.doi.org/10.1016/j.jtcvs.2013.03.009).


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