A Tale of Triumph: Overcoming Challenges in Surgical ASD Closure for a Patient with Warm AIHA.

Nicodemus N Triatmojo, Valerinna Yogibuana Swastika Putri, Anna Fuji Rahimah, Gracelia Ruth Elizabeth Damanik, Koernia Kusuma Wardhana
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Abstract

Background: Autoimmune hemolytic anemia (AIHA) is a rare disorder in hematology, with an incidence of 1-3 per 100,000 per year. The current data available on open-heart procedures in patients with AIHA is limited. Despite presenting periprocedural challenges, multidisciplinary efforts enabled the successful performance of surgical atrial septal defect (ASD) closure in a patient with warm-reactive AIHA.

Case presentation: A 56-year-old woman with a large elliptical ASD was planned for surgical closure. The patient has never received a blood transfusion or experienced any previous hematological issues. During the surgical preparation, the patient's immunoglobulin G Coombs test result was positive for the presence of immunoglobulin G. The patient was diagnosed with a remission state of warm AIHA. A challenge arose when surgical ASD closure needed a cardiopulmonary bypass (CPB), which increased the risk of hemolysis. The patient also needed to be hypothermic to reduce metabolism, which may interact with the pathophysiology of AIHA. Several approaches were taken, and the procedure was conducted successfully without noteworthy obstacles.

Conclusion: A successful surgical ASD closure was performed in a patient with complete remission of warm-reactive AIHA. Considering the different hemolytic mechanisms between CPB and AIHA, determining whether AIHA is cold or warm reactive is crucial for managing temperature in the heart-lung machine. Several approaches, such as utilizing a roller pump, a heparin-coated circuit, and administering steroids, can be implemented to prevent hemolysis.

一个胜利的故事:克服手术关闭ASD患者温暖的AIHA的挑战。
背景:自身免疫性溶血性贫血(AIHA)是血液学中一种罕见的疾病,每年的发病率为1-3 / 100000。目前可获得的关于AIHA患者开胸手术的数据有限。尽管存在围手术期的挑战,多学科的努力使得外科房间隔缺损(ASD)关闭在一例热反应性AIHA患者中的成功表现。病例介绍:一名56岁女性,患有大椭圆型ASD,计划手术闭合。患者从未接受过输血或经历过任何血液学问题。在手术准备过程中,患者免疫球蛋白G库姆斯试验结果为G免疫球蛋白阳性,诊断为温性AIHA缓解状态。当ASD手术闭合需要体外循环(CPB)时,挑战出现了,这增加了溶血的风险。患者还需要降低体温以降低代谢,这可能与AIHA的病理生理相互作用。采取了几种方法,手术顺利进行,没有明显的障碍。结论:一例热反应性AIHA完全缓解的患者成功完成了ASD手术闭合。考虑到CPB和AIHA溶血机制的不同,确定AIHA是冷反应还是热反应对于控制心肺机内的温度至关重要。几种方法,如利用滚轴泵,肝素包被电路,并给予类固醇,可以实施,以防止溶血。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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