Korean J Anesthesiol.  2008 Aug;55(2):233-236. 10.4097/kjae.2008.55.2.233.

The anesthetic management of mitral valve replacement in the patient with paroxysmal nocturnal hemoglobinuria: A case report

• Hong SJ
• Lee JY
• Chon JY
• Park JH

• KMID: 2299210
• DOI: http://doi.org/10.4097/kjae.2008.55.2.233

Abstract

Paroxysmal nocturnal hemoglobinuria (PNH) is a disorder of stem cells resulting in complement-mediated red cell lysis. Potential complications of cardiac surgery in patients with PNH include increased risk of infection due to neutropenia, hemolytic crisis as a result of complement activation during cardiopulmonary bypass, and bleeding if thrombocytopenic. We report a case of anesthetic management for mitral valve replacement surgery in a patient with PNH. Preoperative management included the administration of granulocyte-stimulating factor, red cell transfusion, steroid, and prophylactic antibiotics and prevention of thrombosis. Intraoperative and early postoperative management included filtering leukocyte from homologous blood, avoidance of plasma transfusion and replacement of platelet to control bleeding. Although the postoperative course was not smooth because of delayed wound healing, the patient had recovered well.

Keyword

cardiac surgery; paroxysmal nocturnal hemoglobinuria

MeSH Terms

Anti-Bacterial Agents
Blood Platelets
Cardiopulmonary Bypass
Complement Activation
Hemoglobinuria, Paroxysmal
Hemorrhage
Humans
Leukocytes
Mitral Valve
Neutropenia
Plasma
Stem Cells
Thoracic Surgery
Thrombosis
Wound Healing
Anti-Bacterial Agents