Intraoperative Detection of Cold Agglutinins During Cardiopulmonary Bypass in a Child

Cold agglutinins are auto-antibodies, usually of the IgM class, that are present in low titers in the blood of normal individuals. They are generally of no clinical significance in healthy patients because they are active only at extremely low temperatures (less than 10 °C). However, when present in high titers, during periods of hypothermia, they may have clinical impact. We present a child presenting for surgery for congenital heart disease, in whom blood agglutination was noted during hypothermia while on cardiopulmonary bypass (CPB). The history of cold agglutinin disease is presented, typical clinical manifestations are discussed, and options for perioperative care including the conduct of CPB are presented. J Med Cases. 2015;6(3):109-112 doi: http://dx.doi.org/10.14740/jmc2034w