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

Massimiliano Fontana

Division of Immunology and Allergy, CHUV, 1011 Lausanne, Switzerland

Patrick Ruchat

Judith Horisberger

Division of Cardiovascular Surgery, CHUV, 1011 Lausanne, Switzerland

Vincent Aubert

Carole Mayor

François Spertini

Division of Immunology and Allergy, CHUV, 1011 Lausanne, Switzerland

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.

Perfusion, Vol. 21, No. 5, 263-265 (2006)
DOI: 10.1177/0267659106073977
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