CASE REPORTS  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):185-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Washing of the residual solution of cardiopulmonary bypass circuit after coronary artery bypass grafting in idiopathic thrombocytopenic purpura

Ohno H., Higashidate M., Yokosuka T.

From the Department of Cardiovascular Surgery Yokohama National Hospital, Yokohama, Kanagawa, Japan

A 76-­year-old ­female ­with chron­ic idiopath­ic throm­bo­cy­to­pen­ic pur­pu­ra ­required cor­o­nary ­bypass graft­ing. Preoperative treat­ment ­with ­high-­dose intra­ve­nous immu­no­glob­u­lin at a ­dose of 0.4 g/kg/day ­raised the plate­let ­count ­from 57,000 to 110,000/µL. After ter­mi­na­tion of car­di­o­pul­mo­nary ­bypass (CPB) the resid­u­al ­blood in the CPB cir­cuit was ­washed to ­reduce ­total immu­no­glob­u­lin G (IgG) lev­el, includ­ing plate­let-asso­ciat­ed immu­no­glob­u­lin G (PA-IgG), and ­returned to the ­patient. Intraoperative plate­let trans­fu­sion was ­used due to a ­drop in plate­let ­count to the pre­treat­ment lev­el. The post­op­er­a­tive lev­el of IgG and PA-IgG ­remained sig­nif­i­cant­ly low­er ­than pre­op­er­a­tive­ly. The post­op­er­a­tive ­course was unevent­ful and with­out bleed­ing com­pli­ca­tions. Perioperative man­age­ment of a ­patient ­with idiopath­ic throm­bocy­to­pen­ic pur­pu­ra under­go­ing ­open-­heart sur­gery is dis­cussed.