Cold agglutinins: preoperative diagnosis leads to an uneventful perfusion

This report presents the successful use of normothermic cardiopulmonary bypass (CPB) and warm continuous retrograde cardioplegia to facilitate coronary artery bypass grafting (CABG) in a patient with cold agglutinins. As a result of their agglutinating action and resultant haemolysis, cold-reactive autoantibodies have the potential for causing morbidity and mortality when a patient is placed on hypothermic CPB and the heart is arrested with profoundly cold cardioplegia. The crux of the situation is to keep the temperature above the critical temperature of the cold agglutinin; this technique guarantees accomplishing that goal.