Cold agglutinin disease coexisting with left main coronary artery involvement and ventricular dysfunction - a
Dhiren Shah1, Kishore Gupta1, Ankit Jitani2
1Department of Cardiac Surgery, Marengo CIMS Hospital, Science City Road, Ahmedabad, Pin-380060 India.
Insights
Cold hemagglutinin disease (CHAD) is a rare autoimmune disorder. This case report shows successful surgical management of CHAD with cardiac issues using targeted therapies and hypothermia prevention.
Area of Science:
- Hematology
- Immunology
- Cardiology
Background:
- Cold hemagglutinin disease (CHAD) is a rare autoimmune disorder.
- CHAD involves cold-reactive antibodies leading to red blood cell destruction.
- Managing CHAD patients with cardiac comorbidities presents significant clinical challenges.
Observation:
- A 56-year-old male with CHAD, coronary artery disease, and left ventricular dysfunction required coronary artery bypass grafting (CABG).
- The patient experienced intraoperative challenges including rapid hemoglobin drop and limited blood supply.
- Pre-existing cardiac conditions complicated the surgical risk.
Findings:
- Successful management was achieved through a combination of rituximab and bortezomib.
- A strict perioperative protocol to prevent hypothermia was critical.
- The patient's hemoglobin levels were stabilized, and the cardiac surgery was completed.
Implications:
- This case highlights the feasibility of surgical intervention in CHAD patients with cardiac comorbidities.
- Multidisciplinary collaboration among hematologists, anesthetists, and surgeons is essential for optimal outcomes.
- Tailored treatment strategies, including immunomodulatory drugs and careful perioperative care, are vital for managing complex CHAD cases.
Abstract:
Cold hemagglutinin disease (CHAD) is a rare autoimmune condition characterized by cold-reactive antibodies causing hemagglutination and complement-mediated hemolysis. This case report details the successful management of a 56-year-old male with CHAD, coronary artery disease, and left ventricular dysfunction. The patient underwent coronary artery bypass grafting (CABG) amid challenges, including a rapid drop in hemoglobin levels, limited compatible blood supply, and cardiac comorbidities. Treatment involved rituximab, bortezomib, and a meticulous perioperative protocol to prevent hypothermia. The multidisciplinary approach, including hematologists, anesthetists, and surgeons, played a crucial role in managing the triad highlighting the importance of tailored management in CHAD cases.
