Preoperative immunoglobulin treatment in patients with Werlhof's disease undergoing cardiac operation

Background. Patients with Werlhof's disease and undergoing a cardiac surgic al procedure with cardiopulmonary bypass are at increased risk for bleeding complications We report the usefulness of preoperative immunoglobulin trea tment in selected patients. Methods. Between May 1995 and July 1998, 10 patients with Werlhof's disease underwent a cardiac surgical procedure with cardiopulmonary bypass in our department. Five patients with mean platelet counts of less than 80 x 10(9) /L received immunoglobulin therapy preoperatively (group 1). The other 5 pa tients with mean platelet counts higher than 89 x 10(9)/L were not so treat ed (group 2). Results. In group 1, mean platelet count increased from 54 x 109/L 5 days b efore operation to 112 x 109/L after immunoglobulin treatment (p = 0.018) a nd did not fall to less than 60 x 109/L postoperatively. Patients in group 1 received 16 units of packed red blood cells and 5 units of platelet conce ntrate. Patients in group 2 required 24 units of packed red blood cells, 5 units of platelet concentrate, and 23 units of fresh frozen plasma. Only 1 patient (group 2) had a surgical bleeding complication that required reexpl oration. Mean drainage loss was 1,100 mt in group 1 and 1,210 mt in group 2 . Conclusions. Our data demonstrate that immunoglobulin treatment of patients with Werlhof's disease and mean platelet counts of less than 80 x 10(9)/L significantly augments platelet counts preoperatively. It may be useful in selected patients. (C) 2000 by The Society of Thoracic Surgeons.