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The Role of Cold Agglutinins Screening in Cardiac Surgery: Necessity or Redundancy?
Osman Fehmi Beyazal1, Bilge Ecemis Yilmaz2, Korhan Erkanli2
1Department of Cardiovascular Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye.
Insights
Cold agglutinins (CA) are prevalent in Turkish cardiac surgery patients. Preoperative screening for CA and awareness of cold hemagglutinin disease (CHD) are crucial for patient care during hypothermic procedures.
Area of Science:
- Cardiology
- Hematology
- Immunology
Background:
- Cold agglutinins (CA) are autoantibodies that bind red blood cells at low temperatures.
- Cold hemagglutinin disease (CHD) can cause hemolytic anemia, particularly relevant in cardiac surgery involving hypothermia.
- Understanding CA prevalence is vital for managing perioperative risks.
Purpose of the Study:
- To determine the prevalence of cold agglutinins (CA) in Turkish patients undergoing cardiac surgery.
- To highlight the significance of preoperative CA diagnosis.
- To enhance clinical awareness of cold hemagglutinin disease (CHD) in this population.
Main Methods:
- Retrospective analysis of 4273 patients undergoing elective cardiac surgery (2012-2022).
- Routine preoperative screening for CA.
- Prevalence analysis stratified by age groups (18-49 vs. >50 years) and gender.
Main Results:
- Overall CA positivity was 9.12% (390/4273 patients).
- CA prevalence was higher in women (10.9%) than men (8.07%), p=0.015.
- In men, CA prevalence was higher in the >50 age group (8.9%) compared to the 18-49 group (6.6%), though not statistically significant (p=0.47).
Conclusions:
- Cold agglutinins are significantly prevalent in Turkish cardiac surgery patients.
- Routine preoperative CA screening is recommended due to its implications in hypothermic cardiac surgery.
- Increased clinical awareness of CHD among cardiac surgical teams is necessary.
Objectives:
This study aims to determine the prevalence of cold agglutinins (CA) in patients undergoing cardiac surgery in the Turkish population, to draw attention to the importance of preoperative diagnosis, and to increase clinicians' awareness of cold hemagglutinin disease (CHD).
Methods:
4273 patients who underwent elective cardiac surgery between 2012-2022 were examined. All patients were routinely screened for CA. Patients were divided into two groups: 18-49 years old (Group 1) and over 50 years old (Group 2). Prevalence analysis was performed by comparing these age groups and genders.
Results:
Among all patients, CA was positive in 390 (9.12%). There was no difference between group 1 and group 2 in all patient groups and women. However, CA was found to be higher in group 2 in men compared to group 1 (n=154 (8.9%) and n=65 (6.6%), respectively), p=0.47). CA was found to be higher in women compared to men (n=171 (10.9%), n=219 (8.07%), respectively), p=0.015).
Conclusion:
We found that CAs were considerably high in patients undergoing cardiac surgery in the Turkish population. CA is important for cardiac surgery where hypothermia is used, and we believe that this pathology should be routinely screened in the preoperative period. Due to these rates that cannot be ignored, the clinical awareness of the heart team about CHD should be increased.
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