Cold Hemagglutination Pathophysiology: Evaluation and Management of Patients Undergoing Cardiac Surgery With Induced Hypothermia

• The widespread induction of systemic hypothermia and use of iced cardioplegic solutions in cardiac surgery may promote occasional cold autoagglutination. Routine laboratory methods used to detect cold-agglutinating autoantibodies may not take into account the extremely low temperatures that the heart and body may attain during cardiopulmonary bypass. Several cold-mediated complications have now been encountered during cardiac surgery in patients with both known and unsuspected cold-reactive autoantibodies. This review will provide the clinician with a working knowledge of the cold autoimmune disorders, a rapid method for differential diagnosis in unproved cases, and an ability to select techniques for reliable myocardial and renal protection in both known and unsuspected cases. ( Arch Intern Med 1984;144:1639-1641)