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Cold Agglutinins and Open Heart Surgery


dmpollock

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We had a case a few days ago where a patient with cold agglutinins had open heart surgery. His blood spontaneously agglutinated in the pump circuit during hypothermia.

In previous threads in this forum, cold agglutinins with open heart surgery have already been discussed, and the consensus is that most hospitals do not screen for cold agglutinins for open heart surgery. Since we had a problem case, we will have to screen for them from now on.

I can't find a reference or a procedure on how to do the testing. Would it be a room temperature or some lower temperature? What cells to test? How long to incubate?

If anyone does this testing, or used to do it, can you share the method? Thanks.

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We had a case a few days ago where a patient with cold agglutinins had open heart surgery. His blood spontaneously agglutinated in the pump circuit during hypothermia.

In previous threads in this forum, cold agglutinins with open heart surgery have already been discussed, and the consensus is that most hospitals do not screen for cold agglutinins for open heart surgery. Since we had a problem case, we will have to screen for them from now on.

I can't find a reference or a procedure on how to do the testing. Would it be a room temperature or some lower temperature? What cells to test? How long to incubate?

If anyone does this testing, or used to do it, can you share the method? Thanks.

dmpollock, thank you for sharing your experince with us. Would you describe this case more detailed, for example what is the temperature amplitude of this cold antibody, what is the room temperatue when do the bypass? Thank you!

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The reactions in the blood bank: 1+ at room temp, 4+ at 15 C, and 4+ at 4 C.

I don't have the temperature yet for the bypass surgery.

Thank you. I guess the bypass tube temperature maybe below the room temp, because the blood is stored in 4C. From what you provide I feel to prevent this kind of things happen it is better to do 4C incubation.

This is just my opinon, maybe it is not so right.:P:p

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We had the same issue with a patient clogging up the pump. We immedialtely called our reference blood center and the pathologist there spoke with the anesthesiologist and perfussionist. They decided to up the temperature on the pump about 2 degrees. It seemed to work and did not clog up the pump anymore. They did not want to make this policy and decided to look at it on a case by case basis.

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For our patients going to open heart surgery:

We first perform a Cold Screen at 4 C. If this is Neg, Wk Pos, or 1+ Pos, we stop testing but report out the Cold Screen result. If the Cold Screen is 2+ Pos or stronger, we have our computer set to reflex order (per protocol) a "Thermal Amplitude Study" which includes a Room Temp (22 C) screen, a 15 C screen and a Cold Titer at 4 C.

Every year or so, I ask our CV Surgeons whether we need to continue with this protocol, and they keep saying yes, that this information is valuable to them... so it looks like we'll keep doing it until something changes and they no longer want this testing done.

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For our patients going to open heart surgery:

We first perform a Cold Screen at 4 C. If this is Neg, Wk Pos, or 1+ Pos, we stop testing but report out the Cold Screen result. If the Cold Screen is 2+ Pos or stronger, we have our computer set to reflex order (per protocol) a "Thermal Amplitude Study" which includes a Room Temp (22 C) screen, a 15 C screen and a Cold Titer at 4 C.

This looks like a good protocol. Do you have any references in your procedure?

We were required to bring back an old protocol where we screen an autocontrol at room temperature. If positive, then we test at 15 C and 4 C. As far as I know, this has no basis in the literature, unless there is a reference I haven't been able to find.

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For our patients going to open heart surgery:

We first perform a Cold Screen at 4 C. If this is Neg, Wk Pos, or 1+ Pos, we stop testing but report out the Cold Screen result. If the Cold Screen is 2+ Pos or stronger, we have our computer set to reflex order (per protocol) a "Thermal Amplitude Study" which includes a Room Temp (22 C) screen, a 15 C screen and a Cold Titer at 4 C.

Every year or so, I ask our CV Surgeons whether we need to continue with this protocol, and they keep saying yes, that this information is valuable to them... so it looks like we'll keep doing it until something changes and they no longer want this testing done.

sgoertzen ,if the 4 C 2+ is Pos or stronger, but the 15C and 22C is neg, how to deal with it? I mean in the operating process. And if the 4C and 15C is Pos , but 22C is Neg, how to deal with it? Thank you!

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This looks like a good protocol. Do you have any references in your procedure?

We were required to bring back an old protocol where we screen an autocontrol at room temperature. If positive, then we test at 15 C and 4 C. As far as I know, this has no basis in the literature, unless there is a reference I haven't been able to find.

Sorry, no fancy references for our protocol. It is just something that the cardiac surgeons and our medical director decided upon years ago and it seems to work really well for us.

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We had a case a few days ago where a patient with cold agglutinins had open heart surgery. His blood spontaneously agglutinated in the pump circuit during hypothermia.

In previous threads in this forum, cold agglutinins with open heart surgery have already been discussed, and the consensus is that most hospitals do not screen for cold agglutinins for open heart surgery. Since we had a problem case, we will have to screen for them from now on.

I can't find a reference or a procedure on how to do the testing. Would it be a room temperature or some lower temperature? What cells to test? How long to incubate?

If anyone does this testing, or used to do it, can you share the method? Thanks.

See AABB Technical Manual 16th edition Method: 4-7 Cold Agglutinin Titer procedure. If titer >64 we perform thermal amplitue and our medical director consults with the surgeon for open heart cases after the review of test results.

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