Deep Hypothermic Circulatory Arrest for Emergency Repair of Type A Aortic Dissection in a Patient with Cold Agglutinins

Overview

Journal J Extra Corpor Technol

Publisher EDP Sciences

Specialties Biotechnology
General Surgery
Health Services

Date 2022 Jan 7

PMID 34992321

Authors

Syena Sarrafpour

Ruma Bose

Affiliations

Soon will be listed here.

Abstract

Cold agglutinins (CA) are auto-antibodies that adhere to erythrocytes in cold temperatures, and can result in agglutination of red blood cells. This process can cause complement-mediated intravascular hemolysis, which can be catastrophic. We describe a patient who developed CA during initiation of deep hypothermic circulatory arrest for emergent repair of Type A aortic dissection. The patient was found to have anti-I and anti-C antibodies and a positive direct Coombs test. CA resolved with re-warming, and resulted in no adverse events.

References

Hoffman Jr J, Gilbert T, Hyder M . Cold agglutinins complicating repair of aortic dissection using cardiopulmonary bypass and hypothermic circulatory arrest: case report and review. Perfusion. 2002; 17(5):391-4. DOI: 10.1191/0267659102pf601cr. View

Feizi T, Taylor-Robinson D . Cold agglutinin anti-I and Mycoplasma pneumoniae. Immunology. 1967; 13(4):405-9. PMC: 1409209. View

Raut M, Joshi S, Maheshwari A . Cold Agglutinin-Diagnose It Before Cardiac Surgery. J Cardiothorac Vasc Anesth. 2016; 31(1):e11. DOI: 10.1053/j.jvca.2016.09.024. View

Berentsen S, Roth A, Randen U, Jilma B, Tjonnfjord G . Cold agglutinin disease: current challenges and future prospects. J Blood Med. 2019; 10:93-103. PMC: 6497508. DOI: 10.2147/JBM.S177621. View

Tian D, Wan B, Bannon P, Misfeld M, LeMaire S, Kazui T . A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013; 2(2):148-58. PMC: 3741839. DOI: 10.3978/j.issn.2225-319X.2013.03.13. View

Rim J, Chang M, Oh J, Gee H, Kim J, Yoo J . Effects of Cold Agglutinin on the Accuracy of Complete Blood Count Results and Optimal Sample Pretreatment Protocols for Eliminating Such Effects. Ann Lab Med. 2018; 38(4):371-374. PMC: 5895868. DOI: 10.3343/alm.2018.38.4.371. View

Fernandez Suarez F, Fernandez Del Valle D, Gonzalez Alvarez A, Perez-Lozano B . Intraoperative care for aortic surgery using circulatory arrest. J Thorac Dis. 2017; 9(Suppl 6):S508-S520. PMC: 5462730. DOI: 10.21037/jtd.2017.04.67. View

Vo T, Oakey Z, Khan Y, Minckler D . A novel method for demonstrating cold agglutinin disease: a case report. J Med Case Rep. 2018; 12(1):99. PMC: 5905110. DOI: 10.1186/s13256-018-1573-7. View

Ziganshin B, Rajbanshi B, Tranquilli M, Fang H, Rizzo J, Elefteriades J . Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: Safe and effective. J Thorac Cardiovasc Surg. 2014; 148(3):888-98. DOI: 10.1016/j.jtcvs.2014.05.027. View

10.

McCullough J, Zhang N, Reich D, Juvonen T, Klein J, Spielvogel D . Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg. 1999; 67(6):1895-9; discussion 1919-21. DOI: 10.1016/s0003-4975(99)00441-5. View

11.

Ogawa T . Cold Agglutinins in a Patient Undergoing Aortic Arch Repair: Temperature Control and Perfusion Strategy. J Cardiothorac Vasc Anesth. 2019; 33(12):3529-3531. DOI: 10.1053/j.jvca.2019.05.015. View

12.

Berentsen S . Cold agglutinin disease. Hematology Am Soc Hematol Educ Program. 2016; 2016(1):226-231. PMC: 6142439. DOI: 10.1182/asheducation-2016.1.226. View

13.

Southern J, Bhattacharya P, Clifton M, Park A, Meissner M, Mori R . Perioperative management of cold agglutinin autoimmune hemolytic anemia in an older adult undergoing radical cystectomy for bladder cancer. Urol Case Rep. 2019; 27:100998. PMC: 6710374. DOI: 10.1016/j.eucr.2019.100998. View

14.

Shah S, Gilliland H, Benson G . Agglutinins and cardiac surgery: a web based survey of cardiac anaesthetic practice; questions raised and possible solutions. Heart Lung Vessel. 2014; 6(3):187-96. PMC: 4181280. View

15.

Cho S, Kim D, Kwak Y . Normothermic cardiac surgery with warm blood cardioplegia in patient with cold agglutinins. Korean J Thorac Cardiovasc Surg. 2014; 47(2):133-6. PMC: 4000870. DOI: 10.5090/kjtcs.2014.47.2.133. View