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Preoperative immunoglobulin treatment in patients with Werlhof's disease undergoing cardiac operation
S Christiansen1, C Schmid, K Redmann
1Department of Cardiothoracic Surgery, Westphalian Wilhelms-University, Münster, Germany.
Insights
Preoperative immunoglobulin treatment significantly increased platelet counts in patients with Werlhof's disease undergoing cardiac surgery. This approach may reduce bleeding complications in selected high-risk patients.
Area of Science:
- Cardiology
- Hematology
- Immunology
Background:
- Patients with Werlhof's disease undergoing cardiac surgery with cardiopulmonary bypass face elevated bleeding risks.
- Preoperative immunoglobulin therapy is explored as a potential intervention.
Purpose of the Study:
- To evaluate the effectiveness of preoperative immunoglobulin treatment in augmenting platelet counts for patients with Werlhof's disease undergoing cardiac surgery.
- To assess the impact of this treatment on perioperative bleeding complications.
Main Methods:
- A comparative study involving 10 patients with Werlhof's disease undergoing cardiac surgery.
- Group 1 (5 patients) received preoperative immunoglobulin therapy due to mean platelet counts < 80x10(9)/L.
- Group 2 (5 patients) did not receive treatment (mean platelet counts > 80x10(9)/L).
Main Results:
- Immunoglobulin treatment significantly increased mean platelet counts from 54x10(9)/L to 112x10(9)/L (p=0.018) in Group 1.
- Postoperative platelet counts remained above 60x10(9)/L in Group 1.
- Group 1 required fewer blood products compared to Group 2, with only one reexploration for bleeding in Group 2.
Conclusions:
- Preoperative immunoglobulin administration effectively increases platelet counts in patients with Werlhof's disease and low preoperative platelet counts.
- This therapeutic strategy shows promise for selected patients undergoing cardiac surgical procedures to mitigate bleeding risks.
Background:
Patients with Werlhof's disease and undergoing a cardiac surgical procedure with cardiopulmonary bypass are at increased risk for bleeding complications. We report the usefulness of preoperative immunoglobulin treatment in selected patients.
Methods:
Between May 1995 and July 1998, 10 patients with Werlhof's disease underwent a cardiac surgical procedure with cardiopulmonary bypass in our department. Five patients with mean platelet counts of less than 80x10(9)/L received immunoglobulin therapy preoperatively (group 1). The other 5 patients with mean platelet counts higher than 80x10(9)/L were not so treated (group 2).
Results:
In group 1, mean platelet count increased from 54x10(9)/L 5 days before operation to 112x10(9)/L after immunoglobulin treatment (p = 0.018) and did not fall to less than 60x10(9)/L postoperatively. Patients in group 1 received 16 units of packed red blood cells and 5 units of platelet concentrate. Patients in group 2 required 24 units of packed red blood cells, 5 units of platelet concentrate, and 23 units of fresh frozen plasma. Only 1 patient (group 2) had a surgical bleeding complication that required reexploration. Mean drainage loss was 1,100 mL in group 1 and 1,210 mL in group 2.
Conclusions:
Our data demonstrate that immunoglobulin treatment of patients with Werlhof's disease and mean platelet counts of less than 80x10(9)/L significantly augments platelet counts preoperatively. It may be useful in selected patients.
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