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Title of Journal: Int J Hematol

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Abbravation: International Journal of Hematology

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Springer Japan

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DOI

10.1007/s00122-004-1677-x

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1865-3774

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Successful management of perioperative hemostasis

Authors: Yoshiyuki Ogawa Shinji Kunishima Kunio Yanagisawa Yohei Osaki Yuri Uchiyama Naomichi Matsumoto Hideaki Tokiniwa Jun Horiguchi Yoshihisa Nojima Hiroshi Handa
Publish Date: 2016/10/01
Volume: 105, Issue: 2, Pages: 221-225
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Abstract

Perioperative hemostatic management is a challenge in patients with Glanzmann thrombasthenia GT The standard means of preventing surgical bleeding in GT patients is platelet transfusion However GT patients often possess alloantibodies against GPIIb/IIIa and/or HLA which cause resistance to platelet transfusion HLAmatched platelet transfusion plasmapheresis or recombinant humanactivated factor VII rFVIIa are alternative interventions in such cases Monitoring of hemostasis is also critical in the management of GT patients who undergo surgery Here we report the case of a 56yearold female GT patient with antiHLA antibodies who underwent a right total mastectomy without significant blood loss under HLAmatched platelet transfusion Bleeding at the surgical site which occurred on the 18th postoperative day was successfully treated by immediate bolus administration of rFVIIa and subsequent HLAmatched platelet transfusion The perioperative hemostatic state was monitored in combination with bleeding time platelet aggregation assay and flow cytometric analysis of GPIIb/IIIa expression Although a flow cytometric analysis is not a functional assay it enabled the estimation of transfused platelet counts and helped to inform the decision regarding whether to perform the surgery Thus perioperative hemostasis was successfully managed in our GT patient by HLAmatched platelet transfusion rFVIIa administration and the close monitoring of hemostasis

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