problems of cold agglutinins in cardiac surgery: how to manage cardiopulmonary bypass and myocardial protection
نویسندگان
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.
منابع مشابه
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...
متن کاملProblems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection
Article type: Case Report Cold agglutinins are of unique relevance in cardiac surgery because 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 d...
متن کاملHow I manage cold agglutinins.
From the Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan. Address reprint requests to: W. John Judd, FIBMS, MIBiol, Professor of Immunohematology, Department of Pathology, UH-2G332, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0054; e-mail: [email protected]. Received for publication November 2, 2005; accepted No...
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Cold agglutinins (CAs) lead to organ thrombosis or haemolysis due to increased blood viscosity and red blood cell clumping when blood temperature drops below the thermal amplitude for haemagglutination. Although it is well known that CAs are particularly relevant to adult cardiac surgery with hypothermic cardiopulmonary bypass (CPB), paediatric cardiac surgery with congenital heart disease and ...
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عنوان ژورنال:
journal of cardio-thoracic medicineجلد ۲، شماره ۱، صفحات ۱۳۷-۱۴۰
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