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Heart surgery and Cold reacting antibodies


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Regarding heart surgery using the pump where the blood drops to 10 C or so, cold auto/allo antibodies can be a problem. Should one run the cold phase routinely, does anyone? We use the gel method, and so we skip the cold phase in all tests: abscreen, abid, Cxm.

Any thoughts are greatly appreciated.

Thanks

Liz

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Decades ago we used to do a special "cold screen" for the heart patients. The pump operators had references that in the presence of cold-reacting antibodies, blood would pool in the heart when they were finished and/or there would be difficulty restarting the heart . . . How valid, I don't know. There are many places that do not perform cold screens.

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Not sure we should be doing it, but after much urging of our anesthesiologists, we have started doing cold screens again on patients scheduled for heart surgery. We do tube screening at room temperature and at 4 degrees and incubate for 30 minutes. If that screen is positive, we then do a more complete study. We test patient's plasma at 4 degrees, 12 degrees, Room temp, 30 degrees and 37 degrees, with an incubation of 60 minutes. We report out the strength of reaction seen at the different temperatures. Apparently, they have used the information to adjust the core temperature they take the patient to with better outcomes.

Lou Porter, MBA, MT(ASCP), SBB

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We did a cold screen when we first started doing open hearts but we stopped doing them a few years ago. I don't think they bring the patients body temp down as much as they did years ago. We have not heard of any problems since we stopped doing the cold screen.

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I work at a pediatric hospital and we still continue to do the following:

Perform Cold Screen at 4 C first. If 2+ positive or greater, we then set up a thermal amplitude study starting at Room Temp (23 C), then taking it colder to 20 C, 18 C, 12 C, 10 C and we also run a cold titer.

I am hoping to drop this to just a Room Temp, 15 C and 4 C along with a cold titer whenever any patient shows a 2+ or greater on the initial cold screen. I've asked the anesthesiologists whether this is really being used, and they said yes, and they are still hesitant to have us stop doing it. It would be nice if they just ordered it on the cases where they know it will be really important, rather than making it a part of the their pre-printed orders they use for all of the cardiac pump surgeries.

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