Blood Disorders

What common trigger can produce transient cold agglutinins?

• Bacterial infection

• Viral or other infections

• Autoimmune disease

• Drug reaction

Why should elective cardiac surgery be delayed in patients with cold agglutinins if hypothermia is planned?

• Hypothermia increases myocardial oxygen demand

• Hypothermia or cold cardioplegia can provoke agglutination

• Hypothermia increases platelet consumption

• Hypothermia reduces oxygen saturation

What is the basic perfusion strategy for patients with significant cold agglutinins?

• Deep hypothermia with cold prime

• Normothermic bypass with warm prime and warming devices

• Moderate hypothermia with ice slush

• Cold cardioplegia infusion

What procedure is required if the patient must be cooled below the thermal amplitude?

• Exchange transfusion

• Plasmapheresis

• Administration of DDAVP

• Hemodilution

Which is NOT a complication if a severe cold-agglutinin patient is cooled?

• Myocardial infarction

• Renal failure

• Systemic thrombosis

• Pulmonary embolism

How might the dilutional effect of the pump prime help with cold agglutinins?

• It increases antibody concentration

• It lowers antibody concentration, reducing risk

• It removes IgM entirely

• It prevents hemolysis by warming blood

What intra-operative warming measures are recommended for cold-agglutinin patients?

• Use of ice packs

• Use of warm prime and heating blanket

• Avoid heating to prevent vasodilation

• None are necessary

What cardioplegia strategy must be used if blood cardioplegia is chosen for cold-agglutinin patients?

• Cold blood cardioplegia

• Warm blood cardioplegia

• Crystalloid only

• Retrograde cardioplegia

How can cold cardioplegia be administered safely when cold agglutinins are present?

• Use cold blood cardioplegia with rapid rewarming

• Use crystalloid cardioplegia with warm flushing

• Avoid cardioplegia entirely

• Administer cold cardioplegia directly

What temperatures of typical cold blood cardioplegia would do to cold-agglutinin blood?

• Prevent clotting

• Cause almost certain agglutination

• Stabilize antibodies

• Reduce hemolysis