Waldenstrom’s Disease and cardiopulmonary bypass: a case report
Waldenstrom’s Disease and cardiopulmonary bypass: a case report
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瓦尔登斯特伦病和体外循环：病例报告
DOI：
10.1191/0267659104pf774cr
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
G. Webb
中科院分区：
文献类型：
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作者：
Claire A Sweeting;N. Kelleher;N. Mahmood;J. Unsworth‐White;M. Weatherall;G. Webb
Waldenstrom’s Macroglobulinaemia （WM）是一种罕见的血液学淋巴瘤，由于血液中循环的免疫球蛋白M （IgM）水平升高，导致许多血液静止并发症。这些并发症，如高黏度综合征，可能会因体外循环（CPB）的生理作用而加剧。在本病例研究中，一名45岁男性WM患者接受了紧急主动脉瓣置换术、房室瘘闭合术和二尖瓣修复术。手术前，他被发现有血液粘度升高、贫血和高血容量。这些并发症在CPB期间仍然是一个问题，导致循环容量大，但血红蛋白低，需要血液过滤和输血，同时限制血液粘度的进一步上升。电解质紊乱的存在使情况进一步复杂化。结论是，在血液保存技术和温度管理之间需要谨慎的平衡，以减少高粘度和贫血，但保持器官保护。未来，如果有更多的时间，现代血浆置换技术可用于CPB期间WM的急性管理。
Waldenstrom’s Macroglobulinaemia (WM) is a rare haematological lymphoma that causes numerous haemo-static complications due to the elevated levels of immunoglobulin M (IgM) circulating in the blood. These complications, such as hyperviscosity syndrome, may be exacerbated by the physiological effects of cardiopulmonary bypass (CPB). In this case study, a 45-year-old male suffering from WM underwent an emergency aortic valve replacement, closure of an atrio-ventricular fistula and mitral valve repair. He was found to have an elevated blood viscosity, anaemia and hypervolaemia prior to surgery. These complications remained a problem during CPB, leading to a large circulating volume, but a low haemoglobin, requiring haemofiltration and blood transfusions whilst limiting any further rise in blood viscosity. The situation was further compounded by the presence of electrolyte disturbances. It was concluded that a careful balance between blood conservation techniques and temperature management was required to reduce hyperviscosity and anaemia, but maintain organ protection. In future, given more time, modern plasmapheresis techniques could be used for acute management of WM during CPB.