Case Reports

Cardiopulmonary Bypass in the Setting of Waldenström’s Macroglobulinemia

^* School of Cardiovascular Perfusion, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
^† Department of Nurse Anesthesia, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
^‡ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
^§ Procirca Perfusion Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Address correspondence to: Brandon D. D’Aloiso, BSE, CCP, LP, UPMC Procirca School of Cardiovascular Perfusion, 532 South Aiken Avenue, Suite 105, Pittsburgh, PA 15232. E-mail: daloisobd@upmc.edu

Received: 25 September 2017
Accepted: 15 February 2018

Abstract

Waldenström’s Macroglobulinemia (WM) is a rare lymphoma caused by the overproduction of immunoglobulin M (IgM). The elevated level of IgM causes serum hyperviscosity, cold agglutinins, and cryoglobulinemia. Anemia is also present because of impaired production of erythrocytes. For these reasons, placing a patient with WM on cardiopulmonary bypass (CPB) requires careful preparation. In this case, the patient was a 73-year-old male with known Waldenström’s disease who required coronary artery bypass graft surgery. This report details the perioperative considerations used for successful CPB on a Waldenström’s patient. Critical to this case was the use of plasmapheresis before surgery. Temperature management and acid/base status were carefully controlled. A successful coronary revascularization surgery was performed. Many of the Wadenstrom’s disease complications expected on CPB failed to materialize.