title: Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass.
abstract: OBJECTIVE
  Cold agglutinins (CA) are circulating autoantibodies present in most humans. They are active below normal body temperatures. Cold hemagglutinin disease involves the presence of CA sufficiently active at temperatures in the periphery to produce hemolysis or agglutination. Systemic hypothermia and cold cardioplegia may result in agglutination or hemolysis. We reviewed the experience of a large referral center in managing patients with CA and cold hemagglutinin disease undergoing cardiac surgery requiring cardiopulmonary bypass.
  
  
  METHODS
  The electronic medical records from 2002 to 2010 were searched to identify patients with CA or cold hemagglutinin disease who underwent cardiac surgery requiring cardiopulmonary bypass. Information related to preoperative CA testing and treatment, surgery, cardiopulmonary bypass, postoperative complications, and mortality was recorded.
  
  
  RESULTS
  Sixteen patients underwent 19 procedures requiring cardiopulmonary bypass. Six patients had cold hemagglutinin disease. The identification of CA was made intraoperatively in 3 patients. One patient underwent preoperative plasma exchange. Cold blood cardioplegia was used in 2 of 16 procedures using cardioplegia, with the remaining using warmer blood cardioplegia. The lowest recorded intraoperative core temperature was less than 34 °C in 1 case. CA-related postoperative hemolysis requiring transfusion was present in 1 patient, which was resolved with active warming. No patient had evidence of permanent myocardial dysfunction, had a neurologic event, required dialysis, or died within 30 days.
  
  
  CONCLUSIONS
  All patients with CA/cold hemagglutinin disease at the Mayo Clinic College of Medicine safely underwent cardiac surgery without major adverse morbidity or mortality. Patients with CA but without evidence of cold hemagglutinin disease can safely undergo normothermic cardiopulmonary bypass at 37°C and warm cardioplegia without further testing. Patients with cold hemagglutinin disease should undergo laboratory testing including CA titers and thermal amplitude and hematology consultation before cardiac surgery.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Barbara
authors.forename: William J
authors.initials: WJ
authors.lastname: Mauermann
authors.forename: James R
authors.initials: JR
authors.lastname: Neal
authors.forename: Martin D
authors.initials: MD
authors.lastname: Abel
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D003450:Cryoglobulins / Q000032:analysis; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006461:Hemolysis; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003450:Cryoglobulins; C029443:cold agglutinins
keywords: 1; 25; 37; CA; CHAD; CPB; IABP; cardiopulmonary bypass; cold agglutinins; cold hemagglutinin disease; intra-aortic balloon pump