Tholpady Ashok, Bracey Arthur W, Baker Kelty R, Reul Ross M, Chen Alice J
Tex Heart Inst J. 2016 Aug 1;43(4):363-6. doi: 10.14503/THIJ-15-5672. eCollection 2016 Aug.
Cold hemagglutinin disease with broad thermal amplitude and high titers presents challenges in treating cardiac-surgery patients. Careful planning is needed to prevent the activation of cold agglutinins and the agglutination of red blood cells as the patient's temperature drops during surgery. We describe our approach to mitigating cold agglutinin formation in a 77-year-old man with severe cold hemagglutinin disease who underwent off-pump coronary artery bypass surgery without the use of preoperative plasmapheresis. This experience shows that the use of an intravascular warming catheter can maintain normothermia and prevent the activation and subsequent formation of cold agglutinins. To our knowledge, this is the first reported use of this technique in a patient with cold hemagglutinin disease. The chief feature in this approach is the use of optimal thermal maintenance-rather than the more usual decrease in cold-agglutinin content by means of therapeutic plasma exchange.
具有宽热幅度和高滴度的冷凝集素病给心脏手术患者的治疗带来了挑战。在手术过程中，随着患者体温下降，需要精心规划以防止冷凝集素激活和红细胞凝集。我们描述了我们在一名患有严重冷凝集素病的77岁男性患者中减轻冷凝集素形成的方法，该患者接受了非体外循环冠状动脉搭桥手术，未进行术前血浆置换。这一经验表明，使用血管内加热导管可以维持正常体温，并防止冷凝集素的激活和随后的形成。据我们所知，这是首次报道在冷凝集素病患者中使用该技术。这种方法的主要特点是使用最佳的体温维持——而不是通过治疗性血浆置换更常见地降低冷凝集素含量。
