emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1693emcardio-73Research ArticleФундаментальные исследованияFundamental studiesСкрининг холодовых антител у пациентов при операциях на сердце в условиях искусственного кровообращения: да или нет?Screening for cold agglutinins in patients undergoing cardiac surgery with cardiopulmonary bypass: for and againstУшаковаИ. И.UshakovaI. I.

г. Минск

Minsk

ЖмайликР. Р.ZhmailikR. R.

г. Минск

Minsk

ЯрошР. Г.YaroshR. G.

г. Минск

Minsk

КолядкоМ. Г.KaliadkaM. G.

г. Минск

Minsk

ГУ Республиканский научно-практический центр «Кардиология»Republican Scientifical and Practical Centre of Cardiology2022220620256216931699Copyright © Ушакова И.И., Жмайлик Р.Р., Ярош Р.Г., Колядко М.Г., 20252025Ушакова И.И., Жмайлик Р.Р., Ярош Р.Г., Колядко М.Г.Ushakova I.I., Zhmailik R.R., Yarosh R.G., Kaliadka M.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/73

Холодовые агглютинины являются IgM аутоантителами, связывающимися с антигенами на поверхности эритроцитов с большей аффинностью при низких температурах и теряющие активность при увеличении температуры до 37 °C. В популяции наличие холодовых агглютининов может быть, как бессимптомным, так и проявляться клинически холодовой агглютининовой болезнью. Если данные антитела обнаруживаются в низких титрах или не вызывают клинической симптоматики при нормальной температуре тела, они считаются субклиническими или бессимптомными. В данной статье представлено два клинических случая выявления холодовых антител у пациентов, направленных на кардиохирургическое лечение с применением искусственного кровообращения. Данные случаи представляют интерес в связи с отсутствием четких показаний для предоперационного скрининга на наличие холодовых антител. Кроме того, остается неясным в каком случае и при какой температуре достигается клинически значимая агглютинация в условиях системной гипотермии, кровяной холодовой кардиоплегии в случае выявления холодовых агглютининов. В статье также рассматриваются тактики принятия решений при получении положительного результата скрининга.

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.

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The authors declare that there are no conflicts of interest present.