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

Background. Patients with Werlhof’s disease and undergoing a cardiac surgical procedure with cardiopulmonary bypass are at increased risk for bleeding complications. We report the usefulness of preoperative immunoglobulin treatment 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 × 109/L received immunoglobulin therapy preoperatively (group 1). The other 5 patients with mean platelet counts higher than 80 × 109/L were not so treated (group 2). Results. In group 1, mean platelet count increased from 54 × 109/L 5 days before operation to 112 × 109/L after immunoglobulin treatment (p = 0.018) and did not fall to less than 60 × 109/L postoperatively. Patients in group 1 received 16 units of packed red blood cells and 5 units of platelet concentrate. 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 reexploration. Mean drainage loss was 1,100 mL in group 1 and 1,210 mL in group 2. Conclusions. Our data demonstrate that immunoglobulin treatment of patients with Werlhof’s disease and mean platelet counts of less than 80 × 109/L significantly augments platelet counts preoperatively. It may be useful in selected patients.