problems of cold agglutinins in cardiac surgery: how to manage cardiopulmonary bypass and myocardial protection

نویسندگان

kambiz alizadeh cardiac-surgeon department of cardiac surgery, faculty of medicine, mashhad university of medical sciences, mashhad, iran

masoomeh tabari anesthesiologist,department of anesthesiology, faculty of medicine, mashhad university of medical sciences,mashhad, iran

behrooz mottahedi cardiac-surgeon department of cardiac surgery, faculty of medicine, mashhad university of medical sciences, mashhad, iran

delaram sayadpour pathologist, department of pathology, jahad daneshgahi of mashhad, mashhad, iran

چکیده

cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (cpb). cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually igm or iga antibodies) that agglutinate in response to a decrease in body temperature. these disorders include cryoglobulinemia and cold hemagglutinin disease.immunoglobulin m autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. management of anesthesia in these patients includes strict maintenance of normothermia. patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. management of cpb andmyocardial protection requires individualized planning. we describea case of mv repair and cabg in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.normothermic cpb and continuous warm blood cardioplegia weresuccessfully used.

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Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB). Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies) that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M aut...

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Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

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عنوان ژورنال:
journal of cardio-thoracic medicine

جلد ۲، شماره ۱، صفحات ۱۳۷-۱۴۰

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