Cardiac Surgery in a Patient with Idiopathic Thrombocytopenic Purpura: Preoperative High-Dose Immunoglobulin Therapy

(Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan)

Hirohisa Ikegami Tomoaki Suzuki Osamu Nishimura
Takeshi Kinoshita Atsushi Kambara Keiji Matsubayashi
Tohru Asai
A 62-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to undergo cardiac surgery for aortic stenosis, angina pectoris, and paroxysmal atrial fibrillation. A bleeding tendency was expected due to the dramatic decrease in platelets during cardiopulmonary bypass. We performed high-dose transvenous gammaglobulin infusion (400mg/kg/day) for 5 consecutive days immediately before surgery. The gammaglobulin therapy caused steady increase of thrombocytes from 4 days after surgery, even though the platelet count showed no significant change preoperatively. The postoperative course was satisfactory with neither a bleeding tendency nor wound infection. High-dose transvenous gammaglobulin therapy is thus useful for perioperative patients with accompanying ITP, who are often under medication with steroids. This therapy is also effective for prevention of infection.
@Jpn. J. Cardiovasc. Surg. 37: 108-111 (2008)