FRCPath Haem Part 1 MCQs-General Haem 436

A 58-year-old man with a 5-year history of primary cold haemagglutinin disease is referred for urgent coronary artery bypass grafting (CABG) following angiography demonstrating severe triple-vessel coronary artery disease.

Pre-operative investigations reveal:

• Haemoglobin: 94 g/L

• Reticulocyte count: 180 × 10⁹/L

• DAT: strongly positive for C3d only

• Cold agglutinin titre: 1:4096

The cardiac surgeon discusses the planned procedure with the haematology team.

Which of the following is the SINGLE most important peri-operative management strategy to minimise the risk of severe haemolysis and circulatory complications during surgery?

A. Proceed with standard hypothermic cardiopulmonary bypass because complement-mediated haemolysis occurs independently of temperature

B. Perform pre-operative splenectomy to reduce extravascular haemolysis before surgery

C. Administer high-dose corticosteroids for 7 days before surgery and proceed with standard cooling protocols

D. Maintain normothermia throughout the peri-operative period and avoid exposure to temperatures below the thermal amplitude of the cold autoantibody

E. Avoid peri-operative red cell transfusion because transfused red cells are especially susceptible to cold agglutination