Agglutinins and cardiac surgery: a web based survey of cardiac anaesthetic practice; questions raised and possible solutions

INTRODUCTION: Cardiac surgery involves cardiopulmonary bypass during which the core temperature is generally lowered to hypothermic levels. Patients presenting for cardiac surgery are sometimes reported to have cold or warm autoantibodies at the time of blood screening. It is known that cold agglutinins may cause potentially life-threatening haemolysis, intracoronary haemagglutination leading to inadequate cardioplegia distribution, thrombosis, embolism, ischaemia or infarction. The risk (if any) posed by warm autoantibodies is less clear. Because of the absence of hospital policies and of clear UK guidelines that explain how to manage such cases, we decided to conduct a web-based survey regarding standard anaesthesia practice in patients with both cold and warm autoantibodies presenting for cardiac surgery. METHODS: We devised a short electronic survey asking for responses to 8 questions on cold auto-antibodies and 2 on warm auto-antibodies. This was sent to all members of the Association of Cardiothoracic Anaesthetists. Responses were collated and expressed as percentages. Free text responses were analysed for trend or reported verbatim. RESULTS: The results of our survey demonstrate that there is no consensus on the appropriate management of such patients, with responses ranging from cancelling surgery to proceeding without additional precautions. CONCLUSIONS: In collaboration with haematologists and taking into account the available evidence, our institution has now developed a management strategy for cardiac patients with cold autoantibodies. Further studies will be required to determine the usefulness of our algorithm in daily practice.