Coronary Artery By-Pass Grafting in Patient With Paroxysmal Nocturnal Hemoglobinuria (Case Report)
https://doi.org/10.15360/1813-9779-2021-2-27-36
Abstract
Paroxysmal nocturnal haemoglobinuria (PNH) is a clonal haematopoietic stem cell disease that presents with haemolytic anaemia, thrombosis and bone marrow failure. We report a case of a 51-year-old male with a history of PNH in treatment with Eculizumab admitted to our Hospital for acute chest pain and dyspnoea. The diagnosis was a triple vessel disease and patient was scheduled for coronary artery bypass grafting surgery. To balance the risk between thrombosis and bleeding in this particular clinical setting, we decided to use thromboelastography (TEG) as point of care solution and we used the R parameter as the target of our anticoagulant therapy. The R parameter between 11 and 14 sec can be used as a target value to balance the risk; in addition, there was no evidence of acute hemolysis during the surgery and supplemental dose of Eculizumab was administered in order to minimize any potential exacerbation of intravascular hemolysis.
About the Authors
A. Amendola
Hematology and HSC Transplant Center
Italy
Italy
Angela Amendola.
Via Potito Pttrone, 85100 Potenza.
G. Paternoster
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Gianluca Paternoster.
Via Potito Pttrone, 85100 Potenza.
S. P Pascale
Hematology and HSC Transplant Center
Italy
Italy
Sara Pasquina Pascale.
Via Potito Pttrone, 85100 Potenza.
R. Nuccorini
Hematology and HSC Transplant Center
Italy
Italy
Roberta Nuccorini.
Via Potito Pttrone, 85100 Potenza.
M. D'Amora
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Mauro D'Amora.
Via Potito Pttrone, 85100 Potenza.
G. Pittella
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Giuseppe Pittella.
Via Potito Pttrone, 85100 Potenza.
R. D'Ascoli
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Riccardo D'Ascoli.
Via Potito Pttrone, 85100 Potenza.
F. Prestipino
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Filippo Prestipino.
Via Potito Pttrone, 85100 Potenza.
G. Luzi
Department of Cardiac Surgery and Cardiovascular Intensive Care Azienda Ospedaliera Regionale San Carlo
Italy
Italy
Giampaolo Luzi.
Via Potito Pttrone, 85100 Potenza.
M. Pizzuti
Hematology and HSC Transplant Center
Italy
Italy
Michele Pizzuti.
Via Potito Pttrone, 85100 Potenza.
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Review
For citations:
Amendola A., Paternoster G., Pascale S.P., Nuccorini R., D'Amora M., Pittella G., D'Ascoli R., Prestipino F., Luzi G., Pizzuti M. Coronary Artery By-Pass Grafting in Patient With Paroxysmal Nocturnal Hemoglobinuria (Case Report). General Reanimatology. 2021;17(2):27-36. https://doi.org/10.15360/1813-9779-2021-2-27-36
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