Screening for Cold Agglutinins in Open Heart Surgery

[Regina Castor]

Our procedure on screening for cold agglutinins in the Open Heart pateint has recently come under some scrutiny. Is there anyone who would be willing to share their policy?

We screen at 5 degrees and then do a thermal amplitude study if the screen at 5 degrees is positive. However, we do not take into consideration the strength of the reactions.

[John C. Staley]

Our policy is to avoid finding cold agglutinins at all cost. We have a very active open heart program, just about everything except transplants, and have never been asked about cold aglutinins.

They did just read the study about fresh blood and that's going to be a problem but they have never been concerned with cold antibodies, thank goodness.

[Karen Olsen]

We do not routinely screen for cold agglutinins nor perform thermal amplitude studies. Although we have been asked to on several occasions. We do let the perfusionist and surgeon know that their Open Heart patient has a cold agglutinin if we happen to detect it in our normal testing and at what phase it was reactive. We do not go looking for them! This topic comes up about every 7 years!

[Mary]

We have never been requested to screen for cold agglutinins, but we have only been doing open hearts for 7 years. I think they routinely use blood warmers in surgery.

[Rosemary]

We have been dealing with cardiac surgery cases for more than 20 years. This includes cardiac and lung transplants.

Only in the very early days did we screen at a lower temp. but this was 15 -20'C (not 5'C).

About 5 years ago, we did received a couple of requests for cold aggs on patients undergoing cardiac surgery who had chronic Hep C.

Apparently there is an assocation between chronic Hep C and cryoglobulins. So they were ordering Cold Aggs instead of testing for the presence of Cryoglobulins.

If we do find Cold Aggs in our routine testing (which is not often), the anaesthetist is made aware and alerts to use a blood warmer accompany any issued packed cells.

[Yanxia]

ROsemary, would you tell me the meaning of "Cold Aggs", sorry I can't find the explaination,thanks!

[yiams]

This has been a chronic problem for us. When I started we were doing them. Then our open heart group moved away from cold titers, thankfully. That group retired but the gang that replaced them had us go back to cold titers. We screen at 4C. We have had occasional requests for screening at slightly warmer temps (10C or 15C) if the titer is high at >1:32 at 4C. We've respectfully refused because we can't maintain that specific temp very well. None of our pathologists have wanted to address the issue with our surgeons.

[Mabel Adams]

Yanxia, "cold aggs" is short for cold agglutinins.

Didn't the Cleveland Clinic publish useful data a few years back showing testing for cold antibodies was unnecessary?

[Yanxia]

Thank you, Mabel.

[geekay]

Hi there,

In the cardiac centre where I used to be associated with, we were doing the screening for cold agglutinins at 4 C only...later on, the cardiac aneasthetics started insisting on , for 20 C also.

Since then we were doing the testing for 4 C and 20 C.

best wishes....

[geekay]

Hi there,

Our cardiac team was very happy with the 2 temperatures like 4 C and 20 C.

For 20-22 C we used to make use of platelet incubators for incubation !

best wishes...

[geekay]

Thanks Mr Mabel for the valuable info.