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一名患有Glanzmann血小板无力症的患者行冠状动脉搭桥手术的围手术期管理:病例报告

Perioperative management of a patient with Glanzmann thrombasthenia undergoing a coronary artery bypass graft surgery: a case report.

作者信息

Kurdi Mohamad, Frère Corinne, Amour Julien, Brumpt Caren, Delort Josée, Lebreton Guillaume, Croisille Laure, d'Oiron Roseline, Martin-Toutain Isabelle

机构信息

Department of Biological Hematology.

Department of Anesthesia, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière Hospital.

出版信息

Blood Coagul Fibrinolysis. 2018 Apr;29(3):327-329. doi: 10.1097/MBC.0000000000000719.

Abstract

: We report herein the successful perioperative management of a 57-year-old man with a type I Glanzmann thrombasthenia undergoing coronary artery bypass graft surgery and right carotid endarterectomy. The patient suffered from several lesions in the three major coronary arteries and in the right carotid necessitating surgery. Prophylactic human leukocyte antigen (HLA)-matched platelets transfusions were continuous administrated before, and through the immediate perioperative period. Posttransfusion platelet recovery was monitored using flow cytometry to determine the percentage of circulating platelet expressing CD61 (β3). No bleeding complications occurred during and following the procedure. The patient did not develop HLA antibodies or αIIbβ3 antibodies. Thrombophilia screening revealed a heterozygous G20210A prothrombin gene mutation. The patient also suffered from an atrial fibrillation, necessitating anticoagulation therapy. During the hospital stay, a treatment with vitamin K antagonists for stroke prevention was initiated. The patient was discharged 8 days following surgery, and no further complications occurred during the 6 months follow-up.

摘要

我们在此报告一名57岁患有I型Glanzmann血小板无力症的男性患者,在接受冠状动脉搭桥手术和右颈动脉内膜切除术期间的成功围手术期管理。该患者三大冠状动脉和右侧颈动脉有多处病变,需要进行手术。在围手术期之前及整个围手术期立即持续预防性输注人类白细胞抗原(HLA)匹配的血小板。使用流式细胞术监测输血后血小板回收率,以确定表达CD61(β3)的循环血小板百分比。手术期间及术后未发生出血并发症。患者未产生HLA抗体或αIIbβ3抗体。血栓形成倾向筛查显示存在杂合型G20210A凝血酶原基因突变。患者还患有心房颤动,需要进行抗凝治疗。住院期间,开始使用维生素K拮抗剂进行预防中风的治疗。患者术后8天出院,在6个月的随访期间未发生进一步并发症。

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