Perioperative management for a patient with chronic pancytopenia: a case of aplastic anemia with persistent neutropenia following preoperative administration of G-CSF.
The patient, a 62-year-old male suffering from aplastic anemia for 6 years, was admitted in order to undergo laparoscopic cholecystectomy for cholecystitis. Results of laboratory tests at the time of admission revealed pancytopenia: white blood cell count, 1.94 x 10(3)/microl (neutrophil count, 1.23 x 10(3)/microl); red blood cell count, 2.09 x 10(6)/microl; Hb 7.5 g/dl; and platelet count, 3.7 x 10(4)/microl. The patient received supportive therapy prior to surgery, including blood transfusion of red blood cells, platelets and granulocyte colony-stimulating factor (G-CSF). On the day of surgery, the white blood cell count increased to 3.93 x 10(3)/microl (neutrophil count, 2.75 x 10(3)/microl). Surgery ended with no intraoperative complications, but neutropenia progressed and persisted postoperatively: the neutrophil count decreased to 180/microl at its lowest and stayed at about 400-600/microl. This suggests the possibility that repeated preoperative administration of G-CSF may lead to the depletion of granulocyte precursor cells and thus cause harm. Although the patient fortunately achieved a favorable outcome without severe infection, this case is a stark reminder of the difficulties involved in perioperative supportive therapy for patients with chronic pancytopenia.
Nakano
Yoshiko
Y
Department of Anesthesia, Pediatric Anesthesia, Osaka City General Hospital and Children's Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Osaka, 534-0021, Japan.
Okutani
Ryu
R
D000741:Anemia, Aplastic / Q000150:complications*; D000758:Anesthesia / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002764:Cholecystitis / Q000150:complications / Q000601:surgery; D002908:Chronic Disease; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy; D010198:Pancytopenia / Q000150:complications*; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor