Landymore R, Isom W, Barlam B
Can J Surg. 1983 Jan;26(1):79-80.
Cold agglutinins are commonly found in the sera of healthy persons but rarely become clinically important because most agglutinins exert their greatest reactivity at low temperatures. This report describes a patient who successfully underwent aortic valve replacement in the presence of cold agglutinins; it discusses the management of patients with cold agglutinins who undergo open-heart surgery with core hypothermia. Changes in the cell membrane occur when cold circulating antibody combines with complement and antigen present on the surface of the red cell membrane, causing intravascular hemolysis. Two conditions are necessary for the reaction to occur to any appreciable extent: there must be a high enough titre of cold agglutinin and the reactive thermal range must be attained. To avoid these conditions, the core hypothermia should not reach the reactive thermal range or the titre should be reduced either by the standard hemodilution techniques for cardiopulmonary bypass or by plasmapheresis.
冷凝集素常见于健康人的血清中，但很少产生临床意义，因为大多数凝集素在低温下具有最强的反应性。本报告描述了一名在存在冷凝集素的情况下成功接受主动脉瓣置换术的患者；讨论了接受心脏直视手术并伴有核心体温过低的冷凝集素患者的管理。当循环中的冷抗体与存在于红细胞膜表面的补体和抗原结合时，细胞膜会发生变化，导致血管内溶血。要使反应在任何明显程度上发生，需要两个条件：冷凝集素的滴度必须足够高，并且必须达到反应温度范围。为避免这些情况，核心体温不应达到反应温度范围，或者应通过体外循环的标准血液稀释技术或血浆置换来降低滴度。
