Washing of the residual solution of cardiopulmonary bypass circuit after coronary artery bypass grafting in idiopathic thrombocytopenic purpura.
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/microL. 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.
Ohno
H
H
Department of Cardiovascular Surgery, Yokohama National Hospital, Yokohama City, Kanagawa, Japan. ohno@mxu.mesh.ne.jp
Higashidate
M
M
Yokosuka
T
T
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007430:Intraoperative Care; D010976:Platelet Count; D017713:Platelet Transfusion; D011300:Preoperative Care; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous