Watanabe Yasuhiro, Suzuki Tomofumi, Kaneda Toru
Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, 8-2 Oute-machi Aoi-ku, Shizuoka, 420-0853, Japan.
BMC Anesthesiol. 2020 Aug 20;20(1):208. doi: 10.1186/s12871-020-01120-9.
Cardiac surgery under cardiopulmonary bypass (CPB) is often associated with massive bleeding and blood transfusion. For patients requiring specific blood products, meticulous blood management is critical to reduce blood loss, as well as the need for transfusion. Here, we have described the intraoperative blood management in a patient with anti-Ok antibody, who underwent cardiac surgery with CPB.
A 79-year-old woman was scheduled for open aortic valve replacement and tricuspid valve annuloplasty under hypothermic CPB. Her blood type was A RhD(+) Ok(a-), and anti-Ok, an extremely rare antibody against erythrocyte antigen, was detected. Eight units of Ok(a-) frozen thawed red cells (FTRCs), and six units of red blood cells donated by three Ok(a-) individuals were collected just prior to surgery. Although she was anemic, acute normovolemic hemodilution was conducted after anesthesia induction to preserve the autologous whole blood. Four units of FTRCs were loaded in the CPB priming solution, and modified ultrafiltration was adopted during CPB to prevent further hemodilution. After CPB termination, two units of FTRCs, four units of fresh frozen plasma, and ten units of platelet concentrate were intensively transfused, facilitating surgical hemostasis and stable hemodynamics. The autologous whole blood was returned to the patient in the intensive care unit. Since the hemoglobin and hematocrit levels were maintained postoperatively, no additional transfusion was required throughout her hospital stay.
Multidisciplinary intraoperative blood management in a patient with anti-Ok antibody facilitated successful cardiac surgery using CPB, along with effective use of limited blood products.
体外循环（CPB）下的心脏手术常伴有大量出血和输血。对于需要特定血液制品的患者，精心的血液管理对于减少失血以及输血需求至关重要。在此，我们描述了一名患有抗Ok抗体的患者在CPB下进行心脏手术时的术中血液管理情况。
一名79岁女性计划在低温CPB下进行主动脉瓣置换术和三尖瓣环成形术。她的血型为A RhD(+) Ok(a-)，并检测到抗Ok，这是一种极其罕见的针对红细胞抗原的抗体。术前采集了8单位Ok(a-) 冰冻解冻红细胞（FTRCs）以及由3名Ok(a-)个体捐献的6单位红细胞。尽管她贫血，但麻醉诱导后进行了急性等容血液稀释以保存自体全血。4单位FTRCs被加入CPB预充液中，CPB期间采用改良超滤以防止进一步血液稀释。CPB结束后，密集输注了2单位FTRCs、4单位新鲜冰冻血浆和10单位血小板浓缩物，促进了手术止血和稳定的血流动力学。自体全血在重症监护病房回输给患者。由于术后血红蛋白和血细胞比容水平得以维持，她在整个住院期间无需额外输血。
对一名患有抗Ok抗体的患者进行多学科术中血液管理，促进了在CPB下成功进行心脏手术，并有效利用了有限的血液制品。
