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Cold agglutinin disease is a rare form of autoimmune hemolytic anemia mediated mainly by IgM antibodies reacting to surface antigens of the red blood cells at low temperatures causing agglutination and posterior hemolysis on rewarming. Patients with this condition might never be symptomatic, but when they are exposed to hypothermia during cardiovascular procedures, these reactions can be triggered leading to serious organ damage. We describe/discuss a case of a patient with a wide range cold agglutinin disease that became active during coronary artery bypass grafting, the subsequent management and current approaches to this entity in the perioperative setting.

Intraoperative Activation of Very Wide Range Cold Agglutinins during a Cardiac Bypass Case