Intraoperative hypothermia in a patient with cold agglutinin disease.

A patient with cold agglutinin disease developed significant hemolysis after surgery because of intraoperative hypothermia. Convective heat losses from exposed viscera may be more significant than realized. A combination of cold-induced shivering heat loss, cold fluids, and long operations in which large surfaces are exposed can cause cardiac arrhythmias. The elderly patient is particularly susceptible to cold exposure and its consequences during surgery. In this situation of a patient with cold agglutinins, and in others with anitbody-related hemolytic disease, control of temperature during surgery is clearly very important.