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Wednesday, June 19, 2013
Bleeding and Clotting Disorders
Not sure where to put this question so I hope this is the right area. My 13 month old son just had a CVR (cranial vault reconstruction) for craniosynostosis. Prior to the surgery, 2 relatives with the same blood type (B-) donated blood "just in case". After the surgery, his surgeon stated that "it was a good thing he did not need blood because not even the donated blood would have matched. He tested "positive" to many things that he should have tested "negative" to. very rare for a infant that had never had a transfusion before?? He has antibodies in his blood that will need to be investagated by a hemotologist down the road." While in PICU during the first 24 hrs his hemoglobin went to 7.6 where I was told they would normally transfuse but due to his "complication" he will be watched closely and other measures will be used. His hemoglobin was over 12 prior to surgery. The pathologist came and discussed it a little further stating after many hours of testing that they discovered he has anti-M ("cold antibodies"). That most likely he just had a bacteria in his blood and that it should not cause a problem. If he ever needs an emergency blood transfusion that the hospital should be notified so that they can give them the info. During our 5 day PICU stay, we saw many different professionals. A few said, "not a big deal" and a few said that they would see a hemotologist. My son is doing well now, no further complications and so far the surgery appears very successful, but I`m still wondering if I do need to investigate this any further or just assume that he had "bacteria" and it should not be a problem.?? It did make me look back at his neonatal period and the only "odd" things were a positive coombs test with jaundice and his hands and feet stayed purple for about 4 months to the point of people commenting on them. Never thought twice about either until now. Could there be a connection?? Thank you.
While it is not possible to give you a detailed answer without knowing more of the circumstances and data, what I believe you are describing is a cold auto antibody. This is of the IgM subtype and can occur out of the blue. They can be related to infections, and most of the time are transient and go away on their own. Many times, they also do not lead to a significant anemia.
If you have any further questions, the best way to answer them would be to have you meet with a pediatric hematologist who can review your son's case and give you more specific answers.
Spero R Cataland, MD
Associate Professor of Clinical Internal Medicine
College of Medicine
The Ohio State University