—We appreciate Dr Schmidt's comments concerning our recent review of cold hemagglutination pathophysiology during cardiac surgery with hypothermia and cardioplegia.1 We have some observations to add on this issue.
First, very little is known about the clinical significance of cold agglutinins during cardiac surgery with myocardial protection by hypothermia and cold cardioplegia. Much of the experience in cardiac surgery in the past did not include the degree of hypothermia nor the use of cold cardioplegic solutions,2 thus causing us concern about whether this issue had been sufficiently considered. Review of the world's literature has produced only two case reports concerning cold agglutinins, cardiac surgery, hypothermia, and cardioplegia.1,3,4 Unlike others,3,4 we recently saw a case of undetected cold agglutinins causing intracardiac autoagglutination of erythrocytes during iced cardioplegic infusion for emergency cardiac surgery (Figure).5 Fearing coronary microvascular thrombosis with uneven cardioplegic distribution and uneven cooling, we restored heart and body temperature to
Diaz JH, Cooper ES, Ochsner JL. Cold Agglutinins and Hypothermia-Reply. Arch Intern Med. 1985;145(3):579. doi:10.1001/archinte.1985.00360030231059