Abstract
Open heart surgery with hypothermia in patients with cold agglutinin can cause severe complications by hemolysis and hemagglutination of red blood cells. A 41 year-old male patient with mitral stenosis was admitted due to fever and cough. After antibiotics treatment, he was scheduled to undergo mitral valve replacement. In the operation room, we found agglutination of blood cardioplegia during lowering temperature of cardioplegia. And then, the cardioplegia was changed to warm cardioplegia and the operation was performed under normothermia due to the suspicion of the cold reactive protein. The operation was performed uneventfully. Postoperatively, cold agglutinin was confirmed by immunochemistry of the patient\`s serum.
한랭응집소는 저온에서 적혈구의 용혈 및 응집반응을 일으켜 저체온법을 이용한 개심술 시 치명적인 합병증을 일으킨다. 41세 남자 환자가 승모판 협착증을 진단 받고 외래 관찰 도중 기침과 발열 등의 폐렴증상으로 입원하여 항생제 치료 후 승모판 치환술을 받았다. 수술 도중 심정지액의 온도를 내리면서 응집현상을 관찰하고 한랭반응단백질에 의한 응집현상을 의심하여 심정지액을 온혈성으로 바꾸고 정온 체외순환으로 무사히 개심술을 마쳤으며, 수술 후 면역혈청학검사에서 한랭응집소를 확인하였기에 이를 보고하는 바이다.
