Laparoscopic Cholecystectomy Safely Performed for a Patient with Cold Agglutinin Disease

Hiroaki Hata, Hideaki Iwama, Yoshihisa Okuchi, Gen Nishikawa, Satoshi Ogiso, Takashi Yamaguchi, Tetsushi Otani, Nobuyuki Tsuchiya, Toshio Yamato and Kinya Koizumi

Department of Surgery, National Hospital Organization, Kyoto Medical Center

A 75-year-old man with cold agglutinin disease (CAD) who had undergone laparoscopic cholecystectomy was admitted for jaundice and fever, diagnosed as cholelithiasis and choledocolithiasis, and cholecystectomy was planned. CAD is a form of autoimmune hemolytic anemia. Autoantibodies, usually immunoglobulin M, cause red blood cell agglutination and hemolysis at a decreased body temperature. Because perioperative hypothermia is by far the most common perioperative thermal disturbance, special consideration is required in surgical subjects with CAD. Our perioperative approach was to (1) treat CAD medically, (2) avoid a cool environment, (3) consider plasmapheresis, (4) administer erythropoietin, (5) prepare for transfusion, and (6) keep the body temperature to 37°C. These procedures, excluding plasmapheresis, enabled us to safely conduct laparoscopic cholecystectomy for a subject having CAD.

Key words
cold agglutinin disease, surgery, cholecystectomy

Reprint requests
Hiroaki Hata Department of Surgery, National Hospital Organization, Kyoto Medical Center
1-1 Fukakusa-Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555 JAPAN

Accepted
October 28, 2009

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