Kältereaktive Autoantikörper: Perioperatives Management

Zusammenfassung

Kältereaktive Autoantikörper binden bei niedrigen Temperaturen an Erythrozyten und agglutinieren diese. Sie sind, typisch für Autoantikörper, gegen ubiquitär vorhandene Antigene gerichtet und agglutinieren somit nicht nur die autologen Erythrozyten, sondern auch die fast aller Spender. Bei nahezu jedem Menschen sollen bei 0°C Autoantikörper mit niedrigem Titer nachweisbar sein, bei kaum einem fallen sie jedoch auf, da sie schon bei Temperaturen wenig höher als 0°C nicht mehr reaktiv sind und somit weder Symptome verursachen noch bei der immunhämatologischen Routinediagnostik in Erscheinung treten. Nur bei wenigen Patienten verursachen kältereaktive Autoantikörper die Kälteagglutininkrankheit mit Symptomen wie Hämolyse oder Akrozyanose. Diese Patienten bedürfen bei Krankenhausaufenthalten besonderer Aufmerksamkeit und individuell angepasster Prozeduren für die Labordiagnostik oder im Rahmen chirurgischer Eingriffe.

Abstract

Cold-reactive autoantibodies agglutinate red cells at low temperatures. Typical of autoantibodies, they are directed against ubiquitous antigens and therefore agglutinate not only autologous red cells, but also those of almost all donors. Autoantibodies with a low titre are detectable at 0°C in almost every person. In most cases, they are no longer reactive at temperatures a few degrees above 0°C and therefore neither cause symptoms nor do they appear in routine immunohaematological diagnostics. Only in a few patients do cold-reactive autoantibodies cause cold agglutinin disease with symptoms such as haemolysis or acrocyanosis. These patients require special attention during hospitalisation and individually adapted procedures for laboratory diagnostics or for surgical interventions.

Schlüsselwörter

Kältereaktive Autoantikörper - Chirurgie in Hypothermie - Hämolyse

Keywords

Cold-reactive autoantibodies - Surgery in hypothermia - Haemolysis

Publikationsverlauf

Artikel online veröffentlicht:
14. Mai 2025

• Literatur

• 1 Roelcke D. Cold agglutination. Transfus Med Rev 1989; 3: 140-166
• 2 Alaggio R, Amador C, Anagnostopoulos I. et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia 2022; 36: 1720-1748
• 3 Berentsen S. New Insights in the Pathogenesis and Therapy of Cold Agglutinin-Mediated Autoimmune Hemolytic Anemia. Front Immunol 2020; 11: 590
• 4 Ercan S, Caliskan M, Koptur E. 70-year old female patient with mismatch between hematocrit and hemoglobin values: the effects of cold agglutinin on complete blood count. Biochem Med (Zagreb) 2014; 24: 391-395
• 5 La Gioia A, Fumi M, Fiorini F. et al. Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination. J Clin Pathol 2018; 71: 729-734
• 6 Kumanomido J, Ohe M, Nakao E. et al. Cryoballoon Ablation Induced Hyperkalemia due to Possible Cold Agglutinin Disease. Intern Med 2019; 58: 3421-3425
• 7 AWMF. S3 Leitlinie „Vermeidung von perioperativer Hypothermie" -Aktualisierung 2019. Zugriff am 23.12.2024 unter https://www.awmf.org/uploads/tx_szleitlinien/001-018l_S3_Vermeidung_perioperativer_Hypothermie_2019-08.pdf
• 8 Koyama Y, Asami Y, Nishikawa H. et al. Perioperative management of a patient with severe cold agglutinin disease by using multimodal warming measures. Korean J Anesthesiol 2021; 74: 358-360
• 9 Aoki Y, Aoshima Y, Atsumi K. et al. Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis. Anesth Analg 2017; 125: 793-802
• 10 Abdulwahab HAM, Kolashov A, Haneya A. et al. Temperature management in acute type A aortic dissection treatment: deep vs. moderate hypothermic circulatory arrest. Is colder better? Front Cardiovasc Med 2024; 11: 1447007
• 11 Connelly-Smith L, Alquist CR, Aqui NA. et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue. J Clin Apher 2023; 38: 77-278
• 12 Edmiston M, Darehzereshki A, Badhwar V. et al. Perioperative management of cryoglobulinemia in patients requiring cardiac surgery. JTCVS Tech 2023; 21: 92-94
• 13 Mitsuishi A, Miura Y, Saeki K. et al. Total arch replacement for an aortic arch aneurysm with cold agglutinin disease after rituximab and plasmapheresis. J Cardiothorac Surg 2023; 18: 281
• 14 Zoppi M, Oppliger R, Althaus U. et al. Reduction of plasma cold agglutinin titers by means of plasmapheresis to prepare a patient for coronary bypass surgery. Infusionsther Transfusionsmed 1993; 20: 19-22
• 15 Klein HG, Faltz LL, McIntosh CL. et al. Surgical hypothermia in a patient with a cold agglutinin. Management by plasma exchange. Transfusion 1980; 20: 354-357
• 16 Tvedt THA, Steien E, Øvrebø B. et al. Sutimlimab, an investigational C1s inhibitor, effectively prevents exacerbation of hemolytic anemia in a patient with cold agglutinin disease undergoing major surgery. Am J Hematol 2022; 97: E51-E54
• 17 Tjønnfjord E, Vengen ØA, Berentsen S. et al. Prophylactic use of eculizumab during surgery in chronic cold agglutinin disease. BMJ Case Rep 2017; 2017
• 18 Jäger U, Barcellini W, Broome CM. et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting. Blood Rev 2020; 41: 100648