Year: 2025
Type: article
Study design: Observational Study
Abstract: The Role of Cold Agglutinins Screening in Cardiac Surgery: Necessity or Redundancy?C old agglutinins (CA) are autoantibodies that can be found in humans and are rarely of clinical importance.They may be hereditary, idiopathic, or acquired due to malignancies or infections.[1] Cold hemagglutinin disease (CHD) involves agglutination and hemolysis of red blood cells (RBCs) through complement activation at low temperatures.Most cold agglutinin antibodies are polyclonal and benign, but monoclonal ones are usually pathologically defined.Benign autoantibodies can cause hemagglutination and complement fixation below 25°C, whereas monoclonal and pathological ones can activate complement fixation even at 30°C to 37°C.[2][3][4] This is particularly important in cardiac surgery, where hypothermia and cold cardioplegia procedures are performed.Increased viscosity and microthrombosis can lead to cerebral or myocardial infarction, hepatic or renal failure, end-organ damage, and severe hemolysis.[4,5] There is no consensus yet for these patients, but many studies recommend mild hypothermia and warm cardioplegia during surgery in patients with high-titer autoantibodies.[2] Objectives: This study aims to determine the prevalence of cold agglutinins (CA) in patients undergoing cardiac surgery in the Turkish population, to draw attention to the importance of preoperative diagnosis, and to increase clinicians' awareness of cold hemagglutinin disease (CHD).Methods: 4273 patients who underwent elective cardiac surgery between 2012-2022 were examined.All patients were routinely screened for CA.Patients were divided into two groups: 18-49 years old (Group 1) and over 50 years old (Group 2).Prevalence analysis was performed by comparing these age groups and genders.Results: Among all patients, CA was positive in 390 (9.12%).There was no difference between group 1 and group 2 in all patient groups and women.However, CA was found to be higher in group 2 in men compared to group 1 (n=154 (8.9%) and n=65 (6.6%), respectively), p=0.47).CA was found to be higher in women compared to men (n=171 (10.9%), n=219 (8.07%), respectively), p=0.015). Conclusion:We found that CAs were considerably high in patients undergoing cardiac surgery in the Turkish population.CA is important for cardiac surgery where hypothermia is used, and we believe that this pathology should be routinely screened in the preoperative period.Due to these rates that cannot be ignored, the clinical awareness of the heart team about CHD should be increased.
Author: Osman Fehmi Beyazal
Institution: İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi
Language: English
Topic: Blood groups and transfusion
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4411931067