This article has a correction

Please see: BMJ Case Reports 2018;2018

BMJ Case Reports 2017; doi:10.1136/bcr-2017-221888
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Cold agglutinins in a patient undergoing normothermic cardiac operation with warm cardioplegia

Open Access
  1. Tatsuhiko Ogawa
  1. Department of Anaesthesiology, Kochi Health Sciences Center, Kochi, Japan
  1. Correspondence to Dr Tatsuhiko Ogawa, tatsuhiko777{at}
  • Accepted 29 September 2017
  • Published 10 October 2017


Cold agglutinins are autoantibodies that agglutinate red blood cells at low temperatures, leading to haemagglutination and haemolysis. They are generally of no clinical significance. However, when people with cold agglutinins undergo cardiac operation with hypothermia and cold cardioplegia, they can experience complications. Thus, different perioperative management is required for such patients. We describe a 74-year-old man with cold agglutinins incidentally detected on the preoperative screening test. He had never experienced any complications or developed a haematological disease. Since cold agglutinins were incidentally detected on the preoperative test, a special strategy was used to manage the temperature of cardiopulmonary bypass (CPB) and cardioplegia. He successfully underwent normothermic cardiac operation with warm cardioplegia. A continuous retrograde hyperkalaemic infusion and intermittent antegrade infusion of warm cardioplegia with normothermic CPB is one of the best methods to avoid hypothermia and excessive activity and metabolism of the heart, and to provide a suitable operative field.


  • Contributors TO is the sole author of this paper and wrote the whole manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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