Vigilant monitoring of cold hemagglutinin disease patients undergoing heart surgery can help prevent dangerous complications, a case report study says.
The study, “Anaesthetic management for cardiac surgery in patients with cold haemagglutinin disease,” was published in the Indian Journal of Anaesthesia.
Cold hemagglutinin disease (CHAD or CAD) results in red blood cells agglutinating — clumping up — at low temperatures. This leads to red blood cell rupturing, and subsequently to anemia.
Body temperature can drop substantially during cardiopulmonary bypass surgery — heart surgery where a machine temporarily takes over for the heart and lungs during surgery. Therefore, this surgery can cause dangerous complications for CAD patients.
The study describes the cases of two patients who received mitral valve replacement (the mitral valve allows the flow of blood from the left atrium to the left ventricle).
The first case was a 45-year-old man. Over the course of his pre-surgery bloodwork, abnormal clotting led the clinicians to suspect CAD, and further analysis confirmed the presence of cold agglutinins (CAs, the self-reactive antibodies that cause CAD).
Based on this, the patient was placed on prednisolone, a steroid used to control inflammation, until CA levels were confirmed to be low. During the patient’s surgery, the researchers took preventive measures, closely monitoring the patient’s temperature and taking steps to ensure he stayed warm, including warming fluids used in the surgery, using a heating blanket, and even increasing the temperature of the room in which the surgery took place.
The patient had no reported complications and was discharged a week after surgery.
The second patient, a 34-year-old woman with no history of CAD, underwent an “uneventful” surgery and was transferred to the intensive care unit to recover. However, after surgery, her hemoglobin levels were quite low, so a blood transfusion was performed. After this transfusion, the patient had “coca-colored” urine, which prompted the involvement of the hematology team and, subsequently, the identification of CAs.
Subsequently, steps were taken to keep the patient warm and ensure that additional transfusions were appropriately warmed, and no further complications occurred.
Both patients were informed of the results of their tests and issued medical alert cards.
“This case report intends to bring clinical awareness of cold agglutinin disease among anesthesiologists,” the investigators said.
They noted the importance of a multidisciplinary team to care for patients in the time around surgeries, and stressed the importance of vigilant surveillance of CAD patients undergoing surgery to prevent dangerous complications, which can be mitigated — or even avoided — by ensuring that appropriate steps are taken to regulate patients’ body temperatures.