Cold Agglutinin Detected in the Intraoperative Period: A Case of Coronary Bypass

Cold agglutinin disease(CAD) is an autoimmune disease that occurs against erythrocyte antigens. It is usually idiopathic, but some infections can also be a trigger. CAD becomes active in the peripheral circulation at lower temperatures more easily when exposed to cold, causing hemolysis or agglutination. In this article, the management of a coronary bypass case with CA formation in intraoperative period is presented. A 46-year-old diabetic and hypertensive male patient had COVID-19 2 months ago. Cardio-pulmonary bypass(CPB) was initiated with adequate heparinization, and the patient was cooled to 32°C. It was noticed that there were clots in the cardioplegia delivery line(+1°C). Agglutinations were observed in the autologous blood of the patient whose ACT values were normal. After CPB, the operation was completed without any problems and the patient was discharged on the 5th day with recovery. A diagnosis of CAD was made with the results of peripheral smear and immunologic tests. Determination of antibody concentration and thermal amplitude in the preoperative period in patients with CAD is very important. While preparing such patients for surgery, heating of room, patient, fluids, planning of normothermic CPB, and using warm cardioplegia are required. The relationship between CAD and COVID has started to take place in the literature. The patient we presented had a COVID 2 months ago, cold agglutinin may have been induced by COVID or may have arisen idiopathic. Considering that many people may have had a COVID nowadays, care should be taken especially in the perioperative period of cardiac surgery.

Ýntraoperatif Dönemde Fark Edilen Soðuk Aglütinin: Koroner Baypas Olgusu

Soðuk aglütinin hastalýðý(SAH) eritrosit antijenlerine karþý oluþan otoimmün bir hastalýktýr. Genellikle idiopatiktir ancak bazý enfeksiyonlar da tetikleyici olabilir. SAH, soðuða maruz kalýndýðýnda periferik dolaþýmda daha kolay düþen sýcaklýklarda aktif hale gelir, hemoliz veya aglütinasyon oluþmasýna neden olur. Bu yazýda, SA oluþumu intraoperatif dönemde ortaya çýkan bir koroner baypas olgusunun yönetimi sunuldu. 46 yaþýnda diyabetik ve hipertansif erkek hastanýn 2 ay önce COVID-19 geçirdiði öðrenildi. Yeterli heparinizasyon ile kardiyopulmoner baypas(KPB) baþlatýlan hasta 32°C’ye soðutuldu. Operasyon sýrasýnda kardiyopleji gönderim hattýnda(+1°C) çökmeler olduðu farkedildi. ACT deðerleri normal sýnýrlar içinde olan hastanýn otolog kanýnda aglüti-nasyonlar oluþtuðu gözlendi. KPB ardýndan operasyon sorunsuz bitirildi ve hasta 5. gün þifa ile taburcu oldu. Periferik yayma ve immünolojik testlerin sonuçlarýyla SAH tanýsý konuldu. SAH olanlarda preoperatif dönemde antikor konsantrasyonu ve termal amplitüdün belirlenmesi hemolizin derecesini öngörmek açýsýndan oldukça önemlidir. Bu tür hastalar ameliyata hazýrlanýrken odanýn, hastanýn ve sývýlarýn ýsýtýlmasý, normotermik KPB planlanmasý, ýlýk kardiyopleji kullanýlmasý gerekir. SAH ve COVID-19 iliþkisi literatürde yer bulmaya baþlamýþtýr. Sunduðumuz hasta 2 ay önce COVID-19 enfeksiyonu geçirmiþti, soðuk aglütinin bu yüzden indüklenmiþ olabileceði gibi idiopatik olarak da ortaya çýkmýþ olabilir. Günümüzde birçok insanýn COVID-19 enfeksiyonu geçirmiþ olabileceði göz önüne alýndýðýnda özellikle kalp cerrahisinin perioperatif döneminde dikkatli olunmalýdýr.