Open AccessCholecystectomy in a patient with paroxysmal nocturnal haemoglobinuria undergoing ravulizumab maintenance treatment
Author(s) -
Moriyama Mitsuru,
Aota Yasuo,
Okabe Masahiro,
Osaka Yoshiaki,
Katagiri Seiichiro,
Akahane Daigo,
Gotoh Akihiko
Publication year - 2022
Publication title -
ejhaem
Language(s) - English
Resource type - Journals
ISSN - 2688-6146
DOI - 10.1002/jha2.336
Subject(s) - medicine , haemolysis , cholecystectomy , lactate dehydrogenase , surgery , hypoxemia , immunology , biochemistry , chemistry , enzyme
Abstract A 47‐year‐old male with paroxysmal nocturnal haemoglobinuria (PNH) controlled with routine ravulizumab administration suffered a massive haemolytic crisis due to choledocholithiasis. Laparoscopic cholecystectomy was performed 6 weeks after a regular ravulizumab infusion. After surgery, the patient presented with anaemia without marked elevation in lactate dehydrogenase and required two blood transfusions. Tumour necrosis factor‐ α increased more than twofold with reticulocyte suppression after surgery, suggesting the involvement of myelosuppressive cytokines. This case suggests that laparoscopic surgery may be safely performed in patients with PNH receiving ravulizumab maintenance treatment. However, attention should be paid to postoperative anaemia, regardless of breakthrough haemolysis.