Thrombocytosis and neutrophilia associated with oxygenator failure and protamine reaction after cardiopulmonary bypass: a case report and literature review

Vance G. Nielsen, Toshinobu Kazui, Evan A. Horn, Victoria E. Dotson

Research output: Contribution to journalArticlepeer-review

Abstract

Thrombocytosis has been feared as a source of thrombotic complications during the conduct of cardiopulmonary bypass (CPB) for patients undergoing cardiac procedures. We present a patient urgently requiring repair/replacement of three heart valves that had preexisting myelofibrosis with thrombocytosis (platelet count of 800,000 per µl) and neutrophilia (40,000 per µl). Despite achieving an activated clotting time > 500 s with heparin and antithrombin concentrate administration prior to CPB, the pump oxygenator and reservoir demonstrated significant clot just prior to restoration of the patient’s circulation. The patient subsequently suffered a severe protamine reaction that was successfully managed. A review of the literature of similar patients and the relevant cellular and biochemical mechanisms in this setting are presented, with potential therapeutic approaches to prevent such complications noted.

Original languageEnglish (US)
JournalJournal of Thrombosis and Thrombolysis
DOIs
StateAccepted/In press - 2021

Keywords

  • Cardiopulmonary bypass
  • Neutrophilia
  • Platelet factor 4
  • Thrombocytosis
  • Thrombosis

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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