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Hoashi T, Kagisaki K, Moon J, Takahashi Y, Hayashi T, Ichikawa H. Suspected cold agglutination during mild hypothermic pediatric open heart surgery: a report of two cases. J Artif Organs 2015; 18:370-2. [PMID: 25854605 DOI: 10.1007/s10047-015-0836-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Cold agglutination was suspected in 2 pediatric open heart surgery cases during mild hypothermic cardiopulmonary bypass. The first patient was a 2-year-old boy with secundum atrial septal defect. Fifteen minutes after the initiation of mild hypothermic cardiopulmonary bypass, the inlet pressure of oxygenator suddenly elevated from 250 to over 500 mmHg, whereas outlet pressure was maintained. The blood flow rate decreased from 140 to 85 ml/kg/min. At that time, the arterial blood temperature was less than 32°C. Cold agglutinin was highly suspected, so patient was immediately warmed, and the inlet pressure of oxygenator decreased to 250 mmHg when the arterial blood temperature reached to 36°C. Second patient was a 3-year-old boy with secondary developed subvalvular pulmonary stenosis after the repair of double chambered right ventricle at 10 months of his age. Eighteen minutes after the initiation of mild hypothermic cardiopulmonary bypass, the inflow pressure suddenly elevated to 500 mmHg and transmission flow decreased to 55 ml/kg/min. Twenty-three minutes after warming, the pressure fell to a normal level and transmission flow was recovered. The operation continued with normo-thermic cardiopulmonary bypass and crystalloid cardioplegia. Both cases had no postoperative complications related to cold agglutinin such as myocardial infarction, cerebral infarction, or renal insufficiency.
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Affiliation(s)
- Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Koji Kagisaki
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Jiyong Moon
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Yuzo Takahashi
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruyuki Hayashi
- Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
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Cho SH, Kim DH, Kwak YT. Normothermic cardiac surgery with warm blood cardioplegia in patient with cold agglutinins. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:133-6. [PMID: 24782963 PMCID: PMC4000870 DOI: 10.5090/kjtcs.2014.47.2.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 02/19/2014] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Korea. ; Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Korea
| | - Young Tae Kwak
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Korea
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Jain MD, Cabrerizo-Sanchez R, Karkouti K, Yau T, Pendergrast JM, Cserti-Gazdewich CM. Seek and You Shall Find—But Then What Do You Do? Cold Agglutinins in Cardiopulmonary Bypass and a Single-Center Experience With Cold Agglutinin Screening Before Cardiac Surgery. Transfus Med Rev 2013; 27:65-73. [DOI: 10.1016/j.tmrv.2012.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/02/2012] [Accepted: 12/03/2012] [Indexed: 11/24/2022]
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Kansaku R, Kuwaki K, Amano A, Inaba H, Tambara K, Yamamoto T, Sakakibara N. Aortic Valve Replacement to a Patient with High Titer of Cold Agglutinin. Ann Thorac Cardiovasc Surg 2012; 18:259-61. [DOI: 10.5761/atcs.cr.11.01753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Panos A, Murith N, Myers PO, Kalangos A. Aortic Arch Repair and Cold-Reactive Agglutinins: What to Do? Ann Thorac Surg 2007; 84:1403-4. [PMID: 17889019 DOI: 10.1016/j.athoracsur.2006.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 12/12/2006] [Accepted: 12/13/2006] [Indexed: 10/22/2022]
Abstract
We describe a modified perfusion technique for aortic arch repair under mild hypothermia and continuous cerebral and systemic perfusion.
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Affiliation(s)
- Aristotelis Panos
- Clinic for Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland.
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Barzaghi N, Maurelli M, Emmi V, Minzioni G, D'Armini AM, Montecucco C, Salvaneschi L, Barone M, Piovella F. Pulmonary thromboendarterectomy in a patient with cryoagglutinins. J Cardiothorac Vasc Anesth 2000; 14:447-8. [PMID: 10972614 DOI: 10.1053/jcan.2000.7947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N Barzaghi
- Department of Anesthesiology, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Mastrogiovanni G, Masiello P, Iesu S, Senese I, Di Benedetto G. Management of cold agglutinemia with intermittent warm blood cardioplegia and normothermia. Ann Thorac Surg 1996; 62:317. [PMID: 8678675 DOI: 10.1016/0003-4975(96)88940-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Cold agglutinins are commonly found in sera of healthy persons. They rarely become clinically apparent due to their activity at low temperatures. In these patients, cardiovascular operations requiring hypothermia can result in complications such as hemolysis, renal failure, and myocardial damage and can cause unexpected morbidity and mortality. The literature on cold-reactive proteins is reviewed, and methods of diagnosis and management related to cardiac surgery are suggested. Ideally all patients should be routinely tested preoperatively for the antibodies, and appropriate changes in cardiopulmonary bypass and myocardial management plans should be made in positive patients. Preoperative plasmapheresis may be a useful adjunct, especially in patients requiring operation under profound hypothermia and circulatory arrest. Currently, warm heart surgery appears to be the most expedient method. Unexpected detection of agglutination during operation or hemolysis after operation requires a specific treatment plan.
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Affiliation(s)
- S K Agarwal
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Innet LM, Lester JL, Tait N. Cold agglutinins: preoperative diagnosis leads to an uneventful perfusion. Perfusion 1995; 10:343-5. [PMID: 8601047 DOI: 10.1177/026765919501000510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This report presents the successful use of normothermic cardiopulmonary bypass (CPB) and warm continuous retrograde cardioplegia to facilitate coronary artery bypass grafting (CABG) in a patient with cold agglutinins. As a result of their agglutinating action and resultant haemolysis, cold-reactive autoantibodies have the potential for causing morbidity and mortality when a patient is placed on hypothermic CPB and the heart is arrested with profoundly cold cardioplegia. The crux of the situation is to keep the temperature above the critical temperature of the cold agglutinin; this technique guarantees accomplishing that goal.
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Affiliation(s)
- L M Innet
- Cardiovascular Perfusion Program, Barry University, Miami Shores, Florida 33161, USA
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Koppula AS, Jagannath BR, Kanhere AS, Das M, Gupta CM. Management of cold agglutinemia using normothermic intermittent fibrillatory arrest. Ann Thorac Surg 1994; 58:1566. [PMID: 7979710 DOI: 10.1016/0003-4975(94)91978-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Hearnsberger J, Ziomek S, Tobler G, Maxson T, VanDevanter S, Harrell JE. Management of cold agglutinemia with warm heart surgical intervention: A case report. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33728-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Holman WL, Smith SH, Edwards R, Huang ST. Agglutination of blood cardioplegia by cold reacting autoantibodies. Ann Thorac Surg 1991; 51:833-836. [DOI: 10.1016/0003-4975(91)90145-g] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/1990] [Indexed: 11/28/2022]
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