Related Experiment Videos
Cardiac surgery using only autologous blood for a patient with hereditary spherocytosis: a case report
I Yamagishi1, T Sakurada, T Abe
1Department of Cardiovascular Surgery, Akita Medical Center, 6-17 Senshu Kubotamachi, Akita 010-0874, USA.
Insights
Bloodless cardiac surgery is achievable in anemic patients. Strategies like iron supplements, erythropoietin, and autologous blood transfusions effectively raise and maintain hemoglobin levels for safe surgical outcomes.
Area of Science:
- Cardiology
- Hematology
Background:
- Severe aortic valve calcification necessitates aortic valve replacement (AVR) to alleviate ventricular pressure overload.
- Preoperative assessment revealed anemia secondary to hereditary spherocytosis (HS), a condition complicating surgical management.
Observation:
- The patient presented with severe aortic valve calcification and a significant transvalvular gradient, indicating the need for AVR.
- Anemia due to hereditary spherocytosis posed a challenge, increasing the risk associated with potential homologous blood transfusions.
Findings:
- A multi-faceted strategy was employed, including iron supplementation, recombinant human erythropoietin (rHuEPO) administration, and autologous blood transfusion.
- These interventions successfully elevated hemoglobin levels to permit autologous blood donation and maintained them throughout the perioperative period.
- The patient underwent successful cardiac surgery with minimal blood loss, avoiding homologous blood products.
Implications:
- This case demonstrates the feasibility of bloodless cardiac surgery in anemic patients, even those with complex hematological conditions like HS.
- The successful application of combined medical and transfusion strategies highlights their potential for optimizing surgical outcomes and patient safety.
- These findings support the consideration of similar protocols for anemic patients undergoing major cardiovascular procedures to minimize transfusion risks.
Abstract:
A 50-year-old man was admitted to our hospital for possible surgery. Echocardiogram showed severe calcification of the aortic valve, and cardiac catheter examination recorded a gradient greater than 150 mmHg across the valve. These results determined aortic valve replacement (AVR) to relieve the pressure-overloaded ventricle. Preoperative evaluations however, demonstrated anemia derived from hereditary spherocytosis (HS), an inherited hemolytic disorder. In order to avoid homologous blood transfusion, the following strategies were tried; 1) an iron supplement and an injection of recombinant human erythropoietin (rHuEPO); 2) pre- and perioperative autologous blood transfusion; and 3) an aggressive iron supplement just after the surgery. These raised the blood hemoglobin concentration to the criterion where autologous blood donation was started, and maintained the hemoglobin level stable, up to his discharge. In conclusion, bloodless cardiac surgery is possible for cases with anemia, and some strategies should be tried to raise and maintain the blood hemoglobin concentration well.