Prevention of cryoprecipitation during cardiopulmonary bypass in a patient with HIV-HCV co-infections.
BACKGROUND
There are no guidelines for the management of patients with cryoglobulins during cardiopulmonary bypass (CPB) necessitating core hypothermia.


OBJECTIVE
To evaluate a simple, pragmatic protocol of in vitro temperature-dependent cryoprecipitation of serum in patients with cryoglobulinemia before elective cardiac surgery with CPB.


METHODS
A 44-year-old female patient was known for chronic hepatitis C and type III cryoglobulinemia. Elective surgery was planned for an aortic arch aneurysm. A differential serum cryoprecipitation profile was established in vitro prior to surgery.


RESULTS
Whereas, at temperatures < or = 15 degrees C, cryoglobulin levels were > or = 0.112 g/L (normal value < 0.05 g/L), at 20 degrees C and above, the precipitate was < or = 0.016 g/L. Accordingly, surgery was performed without any cryoglobulin-related complications at an extracorporeal circulation temperature of 22-24 degrees C, to minimise the risk of cryoprecipitation.


CONCLUSIONS
In elective cases of surgery with CPB and hypothermia, temperature-dependent differential serum cryoprecipitation profile may be an easy and efficient way to assess a safe peroperative level of temperature to avoid complications due to cryoglobulins, without enhancing the patient's tissue ischemia risks.
Fontana
Massimiliano
M
Division of Immunology and Allergy, CHUV, 1011 Lausanne, Switzerland. massimiliano.fontana@chuv.ch
Ruchat
Patrick
P
Horisberger
Judith
J
Aubert
Vincent
V
Mayor
Carole
C
Spertini
François
F
D000328:Adult; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D002315:Cardiopulmonary Bypass; D011232:Chemical Precipitation; D003449:Cryoglobulinemia / Q000209:etiology*; D003450:Cryoglobulins / Q000737:chemistry*; D017558:Elective Surgical Procedures; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D011300:Preoperative Care; D013696:Temperature
D003450:Cryoglobulins