cold agglutinin for CABG patients

[lyla_n]

is it a must to do cold agglutinin for every Cardiac surgery or CABG patient? What is the aim of doing this cold agglutinin?

[Malcolm Needs ☆]

We never used to do this when I was working in hospitals, eons ago, but I can, however, see the sense in doing some cold work, as the core temperature of the patient is taken down.

That having been said, I would not do more than test the plasma with screening cells at, say, 20oC, and if a reaction is detected, then do more to determine the true thermal range, and warn the surgeon and the pathologist.

[lyla_n]

We never used to do this when I was working in hospitals, eons ago, but I can, however, see the sense in doing some cold work, as the core temperature of the patient is taken down.

That having been said, I would not do more than test the plasma with screening cells at, say, 20oC, and if a reaction is detected, then do more to determine the true thermal range, and warn the surgeon and the pathologist.

thanks.. Here we have a policy of incubating the patients plasma with cord cells and adult O cells at 4 C.. is this the correct way? Is there a standard procedure and protocol for doing cold agglutination testing?

[Malcolm Needs ☆]

I cannot see that point of performing tests at 4oC. Even if the patient is teken into profound hyperthermia, they are not going to take them down that far (unless they are going to cryopreserve them to be revived in the next century)!!!!!!!!!!!!!!

There is a standard procedure, which is descibed in Petz LD, Garratty G. Immune Hemolytic Anemias. 2nd edition, 2004. Churchill Livingstone, but, I understand that this is now out of print and is becoming harder to obtain (ebay and such places may be of help) and George tells me that, because Lawrie has had fairly major surgery recently, there will, sadly, be no 3rd edition.

[SMILLER]

Not sure about cold agglutinins (regarding BB), but cryglobulins can sometimes be an issue in these types of procedures.

Scott

[dld]

Wow, I thought we were the only BB catering to our perfusion team. We started doing mini cold panels for our CABG patients ten years ago when a patient had such a strong cold agglutinin reaction during surgery the perfusionist said the patient's blood started clumping in the cell saver. We use our screening cell set (panoscreen -- 3 cells) and an auto control. We test at immediate spin, room temp 30 minutes and 4C 10 minutes. Obviously the patient temp isn't taken down that cold, but those are the controlled temp ranges we have. We let the perfusionist know what the reactions were (for example, negative at room temp but weak pos at 4C).

[PAWHITTECAR]

My previous employer did cold antibody screen, SC1& SC2 at 4C on all Cardiac surgery patients. If the 4C was positive you did 15C (Ice in water with a thermometer) If that was positive you did RT. A lot of work but luckily very few were positive at 4C.

[rmblack]

We perform a thermal amplitude on all patients going to CVOR that have a cold antibody identified in PRE-OP testing.

[adiescast]

We do not perform cold agglutinins or a cold panel for patients going to CV surgery. If we find a strong cold reactive antibody in routine testing, we make the surgeon aware so they can make appropriate decisions.

[Malcolm Needs ☆]

There has just been a reveiw paper published on the is very subject.

Jain MD, Cabreeizo-Sanchez R, Karkouti K, Yau T, Pendergrast JM, Cserti-Gazdewich CM. Seek and You Shall Find - But Then What Do You? Cold Agglutinins in Cardiopulmonary Bypass and a Single-Center Experience With Cold Aglutinin Screening Before Cardiac Surgery. Transfusion Medicine Reviews 2013 http://dx.doi.org/10.1016/j.tmrv.2012.12.001.

Basically, it says that doing such screens before surgery is a waste of money!

[marvy1]

John Moulds wrote a one-page QandA on this topic in the AABB news (Jan 2010). In sum: don't go looking for a cold ab...if it shows up in the ABORh testing for a cardiac case, there may be use in doing a 28 or 32C thermal range test (as well as the regular 37C). 4C testing is pretty much useless as most everyone reacts at that temp.

[Malcolm Needs ☆]

That almost exactly echoes the findings of this paper (except that they have followed, quite literally, thousands of cases, so their paper is also evidence based).