title: Case Report of Severe Antithrombin Deficiency During Extracorporeal Membrane Oxygenation and Therapeutic Plasma Exchange for Double Lung Transplantation.
abstract: Acquired antithrombin (AT) deficiency is not uncommon in cardiothoracic surgery because of heparin exposure and dilutional or consumptive losses. We report a case of acquired AT deficiency and resultant multiple deep vein thrombosis in a patient with pulmonary fibrosis on veno-venous extracorporeal membrane oxygenation who underwent double lung transplantation with intraoperative therapeutic plasma exchange (TPE) as a part of an immunomodulation regimen for allosensitization. Preoperative heparin anticoagulation resulted in AT deficiency, which was further exacerbated by TPE using albumin. The recovery of AT activity after TPE with plasma was incomplete, and postoperative deficiencies of AT and other anticoagulants might have contributed to deep vein thromboses. The limitation of thromboelastometry in detecting AT deficiency was evident.
authors.affiliation: From the Departments of *Anesthesiology and †Cardiothoracic Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Brittney
authors.initials: B
authors.lastname: Williams
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mazzeffi
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kon
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
mesh_terms: D000991:Antithrombins / Q000097:blood*; D001777:Blood Coagulation / Q000187:drug effects; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology
chemical_list: D000991:Antithrombins; D006493:Heparin