Prevention of cryoprecipitation during cardiopulmonary bypass in a patient with HIV-HCV co-infections

• Published in: Perfusion Vol. 21; no. 5; pp. 263 - 265
• Main Authors: Fontana, Massimiliano, Ruchat, Patrick, Horisberger, Judith, Aubert, Vincent, Mayor, Carole, Spertini, François
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA SAGE Publications 01.09.2006; Sage Publications Ltd
• Subjects: Adult; Aorta - surgery; Aortic Aneurysm - complications; Aortic Aneurysm - surgery; Aortic Valve Insufficiency - surgery; Cardiopulmonary Bypass; Chemical Precipitation; Cryoglobulinemia - etiology; Cryoglobulins - chemistry; Elective Surgical Procedures; Extracorporeal Circulation - methods; Female; Hepatitis C, Chronic - complications; HIV Infections - complications; Humans; Preoperative Care; Temperature
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1177/0267659106073977

Background: There are no guidelines for the management of patients with cryoglobulins during cardiopulmonary bypass (CPB) necessitating core hypothermia. Objective: To evaluate a simple, pragmatic protocol of in vitro temperature-dependent cryoprecipitation of serum in patients with cryoglobulinemia before elective cardiac surgery with CPB. Methods: A 44-year-old female patient was known for chronic hepatitis C and type III cryoglobulinemia. Elective surgery was planned for an aortic arch aneurysm. A differential serum cryoprecipitation profile was established in vitro prior to surgery. Results: Whereas, at temperatures ≤15°C, cryoglobulin levels were ≥0.112 g/L (normal value <0.05 g/L), at 20°C and above, the precipitate was ≤0.016 g/L. Accordingly, surgery was performed without any cryoglobulin-related complications at an extracorporeal circulation temperature of 22-24°C, to minimise the risk of cryoprecipitation. Conclusion: In elective cases of surgery with CPB and hypothermia, temperature-dependent differential serum cryoprecipitation profile may be an easy and efficient way to assess a safe peroperative level of temperature to avoid complications due to cryoglobulins, without enhancing the patient's tissue ischemia risks.