Cold agglutinins (CAs) are autoantibodies that react reversibly with red blood cells (RBCs) at temperatures of, or below, the thermal amplitude for agglutination. This results in increased blood viscosity and sludging of RBC, and may impair perfusion to various organ systems. Although this phenomenon appears rarely in the clinical arena, the incidence of CA is increased substantially in cardiac surgery due to the routine use of hypothermia for organ preservation and systemic metabolic reduction. Once activated, CA are associated with microvascular occlusion, hemolysis, complement fixation, renal and hepatic insufficiency, cerebral insult, and myocardial infarction. Complications from CA may be minimized with appropriate screening, detection, and management in the perioperative period. A prototypical case is described, and pertinent issues regarding CA are reviewed.
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Article Synopsis
- Autoimmune hemolytic anemia (AIHA) is a rare condition characterized by the destruction of red blood cells due to autoantibodies, with two main types: warm AIHA (wAIHA) and cold agglutinin disease (CAD).
- Diagnosis relies on the direct antiglobulin test (DAT), which shows different results depending on the type of AIHA, affecting treatment options, as steroids work for wAIHA, but less so for CAD.
- The article discusses the varying clinical presentations and treatment challenges for AIHA, highlighting new therapies currently in trials for those who do not respond to standard treatments.
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