SCREENING FOR COLD AGGLUTININS IN PATIENTS UNDERGOING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: FOR AND AGAINST

Cold agglutinins are IgM autoantibodies that bind to antigens on the surface of erythrocytes with higher affinity at low temperatures and lose activity when the temperature increases to 37°C. In the population, the presence of cold agglutinins can be both asymptomatic and clinically manifested by cold agglutinin disease. If these antibodies are detected in low titers or do not cause clinical symptoms at normal body temperature, they are considered subclinical or asymptomatic. This article presents two clinical cases of detection of cold antibodies in patients directed to cardiac surgery treatment with the use of cardiopulmonary bypass. These cases are of interest due to the lack of clear indications for preoperative screening for cold antibodies. Besides, it remains unclear under what conditions and at what temperature clinically significant agglutination is achieved in cases of systemic hypothermia and with cold blood cardioplegia in case of detection of cold agglutinins. This article also discusses decision-making tactics after obtaining a positive screening result.