Open AccessAnaesthetic management for cardiac surgery in patients with cold haemagglutinin disease
Author(s) -
Jasbir Singh Khanuja,
Neelam Aggarwal,
Rajat Kapur,
Siddharth Srivastava
Publication year - 2018
Publication title -
indian journal of anaesthesia/indian journal of anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.645
H-Index - 30
eISSN - 0976-2817
pISSN - 0019-5049
DOI - 10.4103/ija.ija_264_18
Subject(s) - medicine , cold agglutinin , haemolysis , cardiopulmonary bypass , intensive care unit , perioperative , cardiac surgery , surgery , complement fixation test , agglutination (biology) , mitral valve replacement , intensive care medicine , anesthesia , antibody , mitral valve , immunology , serology
Cold haemagglutination is a primary or acquired autoimmune disease involving antibodies that lead to agglutination of red blood cells at low temperature followed by complement fixation and haemolysis on rewarming. This disease can lead to adverse consequences in patients undergoing cardiothoracic surgery, especially when hypothermic cardiopulmonary bypass is applied. The authors discuss the management of two patients who underwent mitral valve replacement surgery while cold agglutinins were detected in the perioperative period. In the first patient, the diagnosis was made preoperatively followed by administration of glucocorticoids to achieve acceptable level of antibody titers. The second patient experienced haemoglobinuria during her intensive care unit stay. The case report describes the pathophysiology of cold agglutination, relevant laboratory investigations such as antibody titers and thermal amplitude, identification of at-risk patients, and management strategies to avoid serious complications.