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

## TL;DR

A 42-year-old woman with a rare blood disorder safely underwent abdominal surgery with careful temperature control to prevent complications.

## Contribution

This case report presents a successful anesthetic strategy for managing a patient with cold agglutinin disease during surgery.

## Key findings

- Strict temperature management successfully prevented hemolysis during surgery.
- Core and surface temperatures were maintained at 37°C -38°C throughout the procedure.
- Anesthesia was completed without complications using warming devices and environmental controls.

## Abstract

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.