Proceedings

Simultaneous Aortic Valve Replacement and Splenectomy in the Thrombocytopenic Patient: Case Report

Department of Surgery Division of Cardiovascular and Thoracic Surgery The University of Texas Medical Branch Galveston, Texas

^* Address Correspondence to: Benjamin Schneider, C.C.P. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, The University of Texas Medical Branch, Galveston, Texas 77550.

Abstract

Splenomegaly associated with secondary hypersplenism is characterized by abnormal splenic function in which formed blood elements are sequestered and destroyed. A 47 year-old male diagnosed as having aortic insufficiency and hypersplenism secondary to bacterial endocarditis underwent a successful aortic valve replacement. Such patients present a higher risk, and patient management during cardiopulmonary bypass is complicated by the associated anemia and thrombocytopenia. Platelet concentrate and whole blood were administered after the splenectomy and just prior to cardiopulmonary bypass. The patient was perfused with a bubble oxygenator primed with two units of packed cells and 5% salt poor albumin in a crystalloid solution. Important parameters to monitor closely are activated clotting times, arterial line pressure, and numbers of circulating platelets. The platelet count prior to splenectomy was 49,000/mm³. The number of platelets increased after the addition of platelet concentrate to 107,000/mm³. Upon completion of the aortic valve replacement, the platelet count fell to 58,000/mm³. This represents a 46% decrease in platelets during cardiopulmonary bypass. Leukocytosis is a typical finding after splenectomy, and the white blood cell count increased from 4,500/mm³ presplenectomy to 16,600/mm³ prior to cardiopulmonary bypass and fell slightly to 13,500/mm³ after surgery.