I am conducting this poll to see how many facilities are still looking for cold aggs in patients undergoing cardiopulmonary bypass in Open Heart Surgery. Please respond using the answers below:

1. No, we do not test separately for cold aggs on anyone

2. yes, we test for cags for OHS pts only.

3. yes, we test and also report out thermal range.

4. yes, we test but only tell surgeon cags are present.

5. we routinely look for cags on all pts.

Thanks! Barb G

Barb you make this too easy! ;>)

1. No, we do not test separately for cold aggs on anyone.

Our goal is to NOT find cold aggs and do everything we can to avoid them.

1. No, we do not test separately for cold aggs on anyone.

I'm with John. We take the Sgt. Schultz attitude toward cold agglutinins: we know NOTHING ! ! !

BC

You can't discount the literature that the surgeons and perfusionists are reading. It reminds them that ice-cold cardioplegia solutions can "activate" cold agglutinins during open heart procedures, and contribute to patient death as a rare complication.

Despite what scientific data we can present, their anecdotal literature sometimes says the opposite. And guess which one they remember ...

The solution is to give perfusionists an overview of blood bank operations, during which they are told, among other things, that the blood bank does not check for cold agglutinins. Works for me! Education, education, education!

BC

We do not test specifically for cold agglutinins on anyone. If we do identify a cold agglutinin even though we use Gel Methodology to get rid of them, we would report it out. Coincidently we are discussing this very topic with our OHS surgeons and profusionists right now. They would like us to report all cold agglutinins by phone to the profusionist. Our dilema is that we don't always know at the time of our initial work-up that the patient is going to OHS. AND- since we use Gel the number of cold agglutinins identified is minimal - will we remember the procedure and call them??!!! This topic always resurfaces after a patient has an issue with a cold agglutinin that they did not know about prior to chilling them down. Blame the Blood Bank!

Blood Bankers, Well we were rid of cold titers a number of years back. then we got a new group of cardiac surgeons in and they reappeared. Our pathologists sided with the prevailing forces (the surgeons) and we perform them. We report the titer. We have had requests for a "thermal range" when a titer is considered "abnormal" (>1:32). We've told them we do not have the facilities or equipment to accurately "control" for a narrow range of 15C to 18C or 8C to 12C, for examples. I should also mention we still occasionally get cold titer requests for non-heart patients. When we check their diagnosis in our computer the diagnosis is usually related to an unusual pneumonia. I'd guess close to 98% of our cold titer work is heart surgery related.

We still get orders for Cold Agglutinins occasionally. That is okay. I just make sure the surgeons know that we do our best to keep from routinely identifying them.

BC