Heart Surgery in Cold Agglutinin Disease
Cold agglutinin disease (CAD) is a rare disorder in which the body mistakenly produces antibodies against its own red blood cells. In colder temperatures, these antibodies bind to the red blood cells and target them for destruction.
CAD can cause a problem for heart surgery patients. That’s why it is important to discuss with your doctor the risks to you during surgery and precautions your surgical team should be taking.
What happens during heart surgery?
During some types of heart surgery, surgeons temporarily stop the heart. During this time, a heart-lung machine oxygenates the blood and pushes the blood through the body. This is called a cardiopulmonary bypass. This allows surgeons to operate on the heart while minimizing bleeding. It also helps that the heart isn’t moving during the operation.
To reduce the amount of oxygen the heart tissue needs during surgery, the surgeon may cool the heart. He or she may do this by pouring cool saline over it during surgery, or by cooling the blood as it passes through the heart-lung machine, which also decreases body temperature. This extends the amount of time that surgeons can work on the heart.
What happens in the case of CAD?
Patients with CAD don’t normally have problems with clotting, but anything that decreases body temperature makes it much more likely that clots will form. Because performing heart surgery generally requires cooling the blood, this can be very dangerous for CAD patients. Clots can occur, blocking arteries and causing organ damage.
For that reason, it’s recommended that patients be screened for CAD prior to heart surgery.
What measures should surgeons take to reduce the risk of complications?
The potential complications for each patient are very individual. In general, surgeons should not cool the blood and heart when operating on CAD patients.
Some patients may need transfusions or plasmapheresis prior to heart surgery to reduce the risk of clotting. Some may need transfusions after surgery to compensate for the loss of red blood cells that occurs as a result of hemolysis (bursting of the red blood cells). It is important that doctors warm the blood to body temperature before the transfusion.
Last updated: May 7, 2020
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