Anesthetic Management During Total Abdominal Hysterectomy in a Patient With Cold Agglutinin Disease: A Case Report

Cold agglutinin disease (CAD) is a very rare autoimmune disorder characterized by hemolytic anemia triggered by cold exposure or hypothermia. Thrombotic complications may ensue, with potentially fatal outcomes. The lowering of body temperature under general anesthesia poses risks of triggering agglutination and hemolysis. A 42-year-old female patient with CAD was scheduled to undergo a full abdominal hysterectomy for uterine fibroids. Strict temperature management was implemented in anticipation of hypothermia because extensive abdominal exposure to room air would be required during open surgery. Her core and surface temperatures were monitored via rectal and axillary temperature measurements. To keep her body temperature stably elevated, an amino acid infusion was administered preoperatively, the operating room temperature was set to 30°C, and fluid and forced-air warming devices were used intraoperatively. Throughout the surgery, both core and surface temperatures were successfully maintained at 37°C -38°C, and anesthesia was concluded without the occurrence of hemolysis.