Pre‑operative care for cardiac surgery patients with cold antibody disorder, cryoglobulinaemia and cryofibrinogenemia

Česká verze

Authors: J. Gumulec ^1,2; R. Brát ³; M. Kolek ³; B. Chrástecký ³; M. Kořístka ^1,4; Z. Čermáková ^1,4; L. Nováčková ⁵; L. Šáchová ^1,2; K. Chasáková ^1,2; A. Ranochová ^1,2; M. Ryzí ^1,2; P. Návratová ^1,2; J. Zuchnická ^1,2; C. Bodzásová ^1,2; H. Plonková ^1,2; P. Slezák ^1,2
Authors place of work: Hemato-onkologické a transfuzní centrum FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec ¹; Ústav klinické hematologie FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec ²; Kardiochirurgické centrum FN Ostrava, přednosta prim. MUDr. Radim Brát, Ph. D. ³; Krevní centrum FN Ostrava, přednostka prim. MUDr. Zuzana Čermáková, Ph. D. ⁴; Ústav klinické biochemie FN Ostrava, přednostka prim. RNDr. Ludmila Nováčková ⁵
Published in the journal: Vnitř Lék 2009; 55(3): 236-241
Category: XV. Pařízkovy dny, Nový Jičín, 26.–27. březen 2009

Summary

We present an example of a patient with confirmed cold agglutinin disease who underwent cardiac surgery in hypothermia to illustrate a known fact that, when exposed to cold, cold agglutinins induce haemolysis of erythrocytes and that cryoglobulins and cryofibrinogens may, upon exposition to cold during a surgery under hypothermia, precipitate or gelify and thus increase plasma viscosity and damage microcirculation. Detailed immunological and haematological investigations in all patients awaiting cardiac surgery with a risk of developing hypothermia is not advantageous considering the low number of patients with clinical and laboratory signs of cold agglutinin disease, autoimmune haemolytic anaemia or paroxysmal cold haemoglobinuria and considering that these investigations, in addition, might not detect cryoglobulinaemia and cryofibrinogenemia. Identification of in‑risk patients from the warning signs in the medical history, physical or basal laboratory testing who would subsequently undergo confirmatory investigations to verify the presence of these entities and define them accurately might be a potential solution to this clinical issue. Cardiac surgery strategy and peri-operative care should be tailored to the results of these investigations. Well‑structured, practiced and functional cooperation between clinicians and laboratory personnel is a prerequisite for success in these circumstances.

Key words:
cold agglutinins – cold agglutinin disease – autoimmune haemolytic anaemia – cryoglobulinaemia – cryofibrinogenemia – hypothermia – cardiac surgery

Zdroje

1. Gertz MA. Cold hemolytic syndrome. Hematology Am Soc Hematol Educ Program 2006: 19–23.

2. Ulvestad E, Berentsen S, Bo K et al. Clinical immunology of chronic cold agglutinin disease. Eur J Haematol 1999; 63: 259–266.

3. Kirschfink M, Knoblauch K, Roelcke D. Activation of complement by cold agglutinins. Infusionsther Transfusionsmed 1994; 21: 405–409.

4. Berentsen S, Beiske K, Tjø´nnfjord GE. Primary chronic cold agglutinin disease: An update on pathogenesis, clinical features and therapy. Hematology 2007; 12: 361–370.

5. Nydegger UE, Kazatchkine MD, Miescher PA. Immunopathologic and clinical features of hemolytic anemia due to cold agglutinins. Swemin Hematol 1991; 28: 66–77.

6. Kakkar N. Spurious automated red cell parameters due to cold agglutinins: a report of two cases. Indian J Pathol Microbiol 2004; 47: 250–252.

7. Zandecki M, Genevieve F, Gerard J et al. Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, hemoglobin, red cell indices and reticulocytes. Int J Lab Hematol 2007; 29: 21–41.

8. Zoppi M, Oppliger R, Althaus U et al. Reduction of plasma cold agglutinin titers by means of plaqsmapheresis to prepare a patient for coronary bypass surgery. Infusionsther Transfusionsmed 1993; 20: 19–22.

9. Siami FS, Siami GA. A last resort modality using cryofiltration apheresis for the treatment of cold hemagglutinin disease in a Veteran Administration hospital. Ther Apher Dial. 2004; 8: 398–403.

10. Itagaki T, Kikura M, Ishida C et al. Perioperative management for cardiovascular operations in two patients with cold agglutinin disease. Masui 2008; 57: 869–873.

11. Hamblin T. Management of cold agglutination syndrome. Transfus Sci 2000; 22: 121–124.

12. Rose WF, Hillmen P, Schreiber AD. Immune-mediated hemolytic anemia. Hematology Am Soc Hematol Educ Program 2004; 48–62.

13. Ferri C. Mixed cryoglobulinemia. Orphanet J Rare Diseases 2008; 3: 25.

14. Ferri C, Sebastiani M, Giugioli D et al. Mixed cryoglobulinemia: demographic, clinical, and serological features, and survival in 231 patients. Sem Arthritis Rheum 2004; 33: 355–374.

15. Moriconi L, Ferri C, Puccini R et al. Double filtration plasmapheresis in the treatment of cryoglobulinemic glomerulonephritis. Int J Art Org 1989; 12: 83–86.

16. Osada T, Kawachi K, Uchino T et al. A successful case of thoracic aortic aneurysm with mixed cryoglobulinemia. Nippon Kyobu Geka Gakkai Zasshi 1992; 40: 1100–1104.

17. Yatsu Y, Kimura F, Muraoka M et al. Perioperative management of a patient with cryoglobulinemia for open heart surgery. Masui 1989; 47: 53–56.

18. Korst DR, Kratochvil C. Cryofibrinogen in a case of lung neoplasm associated with thrombophlebitis migrans. Blood 1955; 10: 945–953.

19. Stathakis NE, Karamanolis D, Koukolis Get al. Characterisation of cryofibrinogen isolated from patients plasma. Haemostasis 1981; 10: 195–202.

20. Blain H, Cacoub P, Musset L et al. Cryofibrinogenemia: a study of 49 patients. Clin Exp Immunol 2000; 120: 253–260.