Prevention of cryoprecipitation during cardiopulmonary bypass in a patient                 with HIV-HCV co-infections

Fontana, Massimiliano; Ruchat, Patrick; Horisberger, Judith; Aubert, Vincent; Mayor, Claire; Spertini, François

doi:10.1177/0267659106073977

Cited by 6 publications

(1 citation statement)

References 3 publications

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“…After an extensive literature search, we found many case reports regarding management of CPB and cold agglutinin disease. But there are only six described cases of CPB in patients with cryoglobulinemia ( 4 – 7 , 12 , 13 ). Among them, Fontana et al ( 12 ) described a 44-year-old woman with chronic hepatitis C and type III cryoglobulinemia who underwent a temperature-dependent differential serum cryoprecipitation profile in vitro prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

Fakih

Elueze

Vij

2016

Journal of Community Hospital Internal Medicine Perspectives

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BackgroundCryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB). Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery.Case presentationWe describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG) was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications.ConclusionPreoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.

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Section: Discussionmentioning

confidence: 99%