Cold Antibodies and Open Heart Patients

[kmmoton]

How do you all handle notification of surgeons if a heart patient has a cold antibody?  Also, do you peform additional testing to identify the actual titer of the cold?

[David Saikin]

We used to do a cold screen for the open heart guys (30 yrs ago). We just resulted it out. We ran the 3 screening cells and an auto at IS, RT (5min) and 4C (5 min). If the auto was pos we called it a non-specific. If the auto was neg, we did an abid at the phase of reactivity. If there was specificity, it was discussed with the BB Medical Director as to whether we would look for ag neg rbcs. We did not contact the open heart team - they should have and did find the results in the usual manner, ie., via LIS reports. Never did titers on these.

Edited August 19, 2013 by David Saikin

[OxyApos]

We still have a cardioplegia screen in our manuals as part of our protocol. Our Medical Director won't get rid of it.  But the reality is...we use Capture/ Echo which rarely detects colds.  We make our patients electronic XM eligible with our retype policy.  So the main avenue for detecting colds are not happening.  What they don't know won't hurt them ( the heart team).

 

[Malcolm Needs ☆]

Sorry to come late to this thread, but I have been trying to find a particular paper that may be of interest in this discussion, and I had an enormous amount of trouble locating said paper. Finally, today, I found it - on my desk, under a load of other things. Memo to self - clear up your office more than once a year!

Anyway, the paper is:

Jain MD, Cabrerizo-Sanchez R, Karkouti K, Yau T, Pendergrast JM, Cserti-Gazdewich CM. Seek and you shall find - but then what do you do? Cold agglutinins in cardiopulmonary bypass and a single-center experience with cold agglutinin screening before cardiac surgery. Transfusion Medicine Reviews 2013; 27(2): 65-73. http://dx.doi.org/10.1016/j.tmrv.2012.12.001

It is well worth a read.

[DJN]

We were picking up several anti-Ms a month using the Echos. As the instrument is designed to detect IgG, the conclusion was always that the antibody was reactive at 37 C. Yet, it doesn't make sense to see so many. We noted comments of  interest in the package insert for the Capture-R Ready Screen under Limitations, 11. "...the Indicator Red Cells (may) carry the antigen toward which the IgM antibody is directed. Some IgM antibodies have been found to link Indicator Red Cells to immobilized red blood cell monolayers by binding to antigens on both. Thus, examples of anti-M, anti-Le^a, anti-Le^b, anti-P1,etc that are detected in Capture-R tests should not be assumed to contain an IgG component without further study."

Here is another useful article on cold agglutinins and cold cardioplegia in surgery:  Barbara DW, Mauermann WJ, Neal JR, et al. Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery. Sept 2013  http://dx.doi.org/10.1016/j.jtcvs.2013.03.009