Open AccessOperative consideration in patient with cryoglobulinaemia undergoing cardiac surgery with use of cardiopulmonary bypass
Author(s) -
Saifullah Mohamed,
Akshay J. Patel,
Yassir Iqbal,
Khurum Mazhar,
Timothy R. Graham
Publication year - 2020
Publication title -
journal of surgical case reports
Language(s) - English
Resource type - Journals
ISSN - 2042-8812
DOI - 10.1093/jscr/rjaa214
Subject(s) - medicine , cardiopulmonary bypass , plasmapheresis , perioperative , cardiac surgery , cryoglobulin , context (archaeology) , extracorporeal , surgery , coronary artery bypass surgery , cardiology , artery , antibody , cryoglobulinemia , paleontology , hepatitis c virus , virus , virology , immunology , biology
Cryoglobulinaemia can be defined as the presence of single or mixed immunoglobulins in the serum, which precipitate at sub-homeostatic temperatures and redissolve at higher temperatures. This condition in the context of cardiac surgery can precipitate systemic complications secondary to cold agglutination and lead to significant perioperative problems with the cardiopulmonary bypass machine and the extracorporeal circuit. We present a case of a 74-year-old gentleman with cryoglobulinaemia who underwent mitral valve repair and coronary artery bypass graft surgery. The patient was to undergo preoperative plasmapheresis to reduce circulating levels of cryoglobulin and thereby decrease the risk of potential protein agglutination during cardiopulmonary bypass. Operative considerations included the level of systemic temperature required, the temperature of the cardioplegia solution, level of anticoagulation and the speed and timing of rewarming of the patient to normal homeostatic temperatures. The postoperative management also consisted of early plasmapheresis to further reduce the number of cryoglobulins.