Cold Agglutinins and Cardiac Surgeries

[BenchTech]

Our Perfusion department has recently become concerned with the possible effect of cold agglutinins on their patients. As we test with Gel and use mostly computer cross matches they are looking at possibly having us do cold panels or other cold testing on their patients. We were curious as to how many other places do routine testing for colds on their cardiac patients with negative antibody screens? Thanks :0)

[David Saikin]

This has been an ongoing thing for decades. Apparently, somewhere, there is an article about cold aggl causing "pooling" of blood in the heart impeding its restart. This article was current in the late 1980's/early '90's. The validity of it is suspect, but difficult to refute. I would ask them for the documentation. If they provide it, you have a hard time not performing the test. We used to do a RT screen and if positive, one at 4C. You may have to provide M= blood if you find an anti-M (easy to do with gel).

[Shashah]

Need some advice on benchmarking. We have been doing cold screens forever and our blood bank action team is working on getting rid of it. Right now, we do it on all our open heart patients who are on pumps. The team was asked to gather information on why this might not be a neccesary test. Then we can present this data to the surgery team and hopefully eliminate the testing.

We have called around to other hospitals and it looks like none of the big trauma hospitals are doing cold screens. Wondering if anyone else out there can help us in gathering our data.

Any suggestions/ comments will be greatly appreciated.

Thanks,

Blood Bank Action Team from VA.

[clmergen]

Sorry Shashah, if we did a study on it, I can't find it. We are a large level 1 trauma center and we do open heart cases (including transplants) and we don't do cold screens at all. This has been in place for at least three years as I have only been here three years. I will ask around and see what kind of answers I get. Of course this will happen next week since everyone working right now has been here even less time than me.

[adiescast]

We are also a level 1 trauma center and do MANY cardiac surgery cases every day. We do not perform cold screens on any of them. The only time we perform a cold screen (on any patient) is if we suspect that we have a cold antibody in the panel. I always insist on a cold screen if someone wants to prewarm a screen or panel. I have seen people do prewarms without ever demonstrating that there was a cold antibody to begin with. Even with confirmation, one should be very careful in the use and interpretation of prewarmed tests.

Sorry...I also have no data to support this position aside from the multitude of cardiac surgeries we have done without a single report of one "pooling blood" in the heart or other such adverse effect.

[rcurrie]

We had one potent cold agglutinin cause problems with the heart pump, but that didn't cause us to begin checking for cold agglutinins again. Too much trouble for such a small risk.

[Shashah]

Thanks everyone for your comments. This will really help us present our case for wanted to stop doing cold screens. I will let you all know how it goes.