Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

Abstract

Immune thrombocytopenic purpura (ITP) patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

Pulmonary Endarterectomy in a Patient with Immune Thrombocytopenic Purpura

“…Bleeding after CPB surgery is common with about 7% of patients requiring reoperation to control bleeding [ 5 ]. Preoperative thrombocytopenia, CPB, deep hypothermia, and induced thrombocytopenia as well as platelet dysfunction and postoperative anticoagulation are expected to increase risk of pericardial effusion and cardiac tamponade.…”

“…Preoperative thrombocytopenia, CPB, deep hypothermia, and induced thrombocytopenia as well as platelet dysfunction and postoperative anticoagulation are expected to increase risk of pericardial effusion and cardiac tamponade. Chowdhry et al [ 5 ] reported a patient with ITP with severe coronary artery disease and mitral regurgitation who underwent CABG and mitral valve replacement. Although early outcome of the surgery was uncomplicated, the patient was dead three weeks later with a diagnosis of pericardial tamponade.…”

“…The main treatment of ITP consists of corticosteroids and IVIG. Second and third line therapies, including rituximab, splenectomy, thrombin receptor agonists (TPO-A), and immune-suppressants, are often successful and may cause a long-term increase in the platelet counts [ 5 ]. Patients with asymptomatic mild or moderate thrombocytopenia can be followed up with no treatment as platelet counts greater than 5 × 10 4 /mm 3 are usually not associated with clinically important bleeding.…”

Cardiac surgery in a patient with severe thrombocytopenia: How low is too low?

“…Excessive bleeding after CPB may lead to increased mortality, morbidity, transfusion requirements and re-intervention. [3,4] In a recently described case by Chowdhry et al, the patient was diagnosed with ITP and responded well to pre-operative oral prednisolone and intravenous immunoglobulin. [4] However, following an uneventful surgical procedure, patient was re-admitted due to pericardial tamponade, which required drainage and unfortunately patient succumbed.…”

An Anesthetic Management İn A Coronary Bypass Surgery Of A Patient With İdiopathic Trombocytopenic Purpura

“…ITP tanısı için; izole trombositopeni olması ve trombositopeniye neden olacak ilaç, diğer ajanlar veya klinik olarak ilişkili durumların olmaması gereklidir (1) .…”