title: Cold agglutinins in cardiac surgery: management of myocardial protection and cardiopulmonary bypass.
abstract: Cold agglutinins are of unique relevance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB). Immunoglobulin M autoantibodies to red blood cells, which activate at varying levels of hypothermia, can cause catastrophic hemagglutination, microvascular thrombosis, or hemolysis. Management of CPB and myocardial protection requires individualized planning. We describe a case of aortic valve replacement in a patient with high titre cold agglutinins and a high thermal amplitude for antibody activation. Normothermic CPB and continuous warm blood cardioplegia were successfully used.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Australia. victoria.atkinson@mh.org.au
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Atkinson
authors.forename: Paul
authors.initials: P
authors.lastname: Soeding
authors.forename: Greg
authors.initials: G
authors.lastname: Horne
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003450:Cryoglobulins / Q000009:adverse effects / Q000032:analysis; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D052096:Warm Ischemia / Q000379:methods
chemical_list: D003450:Cryoglobulins; C029443:cold agglutinins