[Rapid Rise of Trans-oxygenerator Pressure Gradient Accompanied by Rapid Decrease of Platelet Counts During...

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
• Heparin is frequently used for anticoagulation during cardiopulmonary bypass.
• Heparin-induced thrombocytopenia (HIT) is a serious immune-mediated complication.

Observation:

• A 77-year-old male patient developed a rapid increase in trans-oxygenerator pressure and a sharp decrease in platelet count shortly after initiating cardiopulmonary bypass with a heparin-coated circuit.
• This clinical presentation raised strong suspicion for heparin-induced thrombocytopenia (HIT).

Findings:

• An emergency replacement of the cardiopulmonary bypass circuit with a non-heparin coated one was performed.
• Postoperative testing did not detect HIT-specific antibodies, suggesting that HIT was unlikely in this case.
• The patient's postoperative course was uneventful, and the on-pump CABG was completed successfully.

Implications:

• This case highlights the importance of prompt recognition and management of potential HIT during cardiac surgery.
• The differential diagnosis of thrombocytopenia during cardiopulmonary bypass should include HIT, even with heparin-coated circuits.
• Negative HIT antibody testing can help rule out the diagnosis and guide further management.