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A Journal on Surgery

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Chirurgia 2014 June;27(3):197-8


language: English

Acute myeloid leukemia diagnosed after myocardial revascularization in cardiopulmonary bypass. Case report

Kovacs J. 1, 3, Căpîlnă R. 2, Modrigan I. 1, Suciu H. 2, 3

1 Anesthesia and Intensive Care, Department of Cardiovascular Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania; 2 Departement of Cardiovascular Surgery, Emergency Clinical County Hospital, Targu-Mures, Romania; 3 University of Medicine and Pharmacy, Targu Mures, Romania


We present the case of a 55-year-old man admitted to our department with unstable angina. Coronarography revealed two vessels disease and the patient was scheduled for elective coronary revascularization. On preanesthetic examination a mild anemia, trombocytopenia and neutrophylia was revealed without evidence of infection. After successful coronary revascularization in cardiopulmonary bypass, on the 3rd postoperative day he was readmitted to intensive care with severe systemic inflammatory syndrome, low cardiac output, hypoxemia, hepatic impairment, acute renal failure. Broad spectrum antibiotherapy was introduced, intravenous colloids and cristalloids started, inotropics and vasopressor administred to maintain cardiac output. The rapid increase in serum creatinine imposed introduction of continuous veno-venous hemofiltration but kidney failure showed no improvement and white blood cells increased gradually, reaching 110 x109/L on 11th postoperative day, with predominance of monocytes. Acute myelo-monocytic leukemia was confirmed by medulogram, and the patient received antineoplastic and antiuricemic treatment. After 6 days of hematologic treatment the patient presents good outcomes, with reversal of leukocytosis, with hepatic and renal dysfunction also showing improvement. He was transferred to hematology without major organ dysfunction. 9 months after cardiac surgery the patient is well from the cardiac point of view, and hematologically in remission.

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