Kambiz Alizadeh - Cardiac-Surgeon Department of Cardiac Surgery, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Masoomeh Tabari - Anesthesiologist,Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad, Iran
Behrooz Mottahedi - Cardiac-Surgeon Department of Cardiac Surgery, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Delaram Sayadpour - Pathologist, Department of Pathology, Jahad Daneshgahi of Mashhad, Mashhad, Iran

Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB). Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies) that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

Bypass, Cold Agglutinins, Cardiac Surgery