Cardiopulmonary bypass in a patient with classic paroxysmal nocturnal hemoglobinuria during treatment with eculizumab

Preoperative administration of eculizumab to prevent surgery‐triggered hemolysis during cesarean section with paroxysmal nocturnal hemoglobinuria

“…Therefore, postoperative complement system activation is a major concern during postoperative management of patients with PNH. Successful preoperative administration of eculizumab to prevent postoperative hemolysis has been reported in other surgeries, for example, in cardiopulmonary bypass . In obstetrics, eculizumab given before cesarean section has been described in a patient with severe antiphospholipid syndrome .…”

“…Successful preoperative administration of eculizumab to prevent postoperative hemolysis has been reported in other surgeries, for example, in cardiopulmonary bypass. 8 In obstetrics, eculizumab given before cesarean section has been described in a patient with severe antiphospholipid syndrome. 9 However, very few similar discussions in obstetrics are reported.…”

Positive Impact of Eculizumab Therapy on Surgery for Budd- Chiari Syndrome in a Patient with Paroxysmal Nocturnal Hemoglobinuria and a Longterm History of Thrombosis

“…To the best of our knowledge, this is the first case report of a successful placement of a splenorenal shunt in a PNH patient with Budd-Chiari syndrome and a long history of thrombosis. In fact, there have been few reported cases of surgery on patients receiving eculizumab therapy: three cholecystectomies, 14-16 one cardiopulmonary bypass, 17 one splenectomy 18 and one liver transplant for Budd-Chiari syndrome sequelae. 9 All these interventions used proper anesthetic and surgical management and attained good post-operative patient outcomes.…”

“…A variety of factors can lead to complement activation and hemolysis in patients with PNH undergoing a surgical procedure, such as anesthetic administration, acidosis, inflammation or transfusions. 12 , 14 , 15 , 17 , 19 Therefore, patients should be monitored for potential early breakthrough hemolysis after the procedure in order to adjust eculizumab dosage in a timely manner if necessary. Complete C5 blockade by eculizumab during the perioperative period was confirmed in some patients by undetectable terminal complement complex evaluated in vivo after surgery.…”

Perisurgical induction of eculizumab in a patient with paroxysmal nocturnal hemoglobinuria

“…Van Bijnen et al [19] performed successful cardiopulmonary bypass surgery in a PNH patient during maintenance treatment with eculizumab. We used 600 mg eculizumab four times (À8, À1, þ6, and þ13 POD).…”