Anesthetic and Transfusion Management of an Immunosuppressed Patient With Infective Endocarditis and Severe Platelet Allergy Undergoing Redo Aortic Root Surgery

Aortic root replacement for infected endocarditis is associated with excessive bleeding and very high mortality. Bleeding management is mostly achieved with allogenic blood product administration, concomitant pharmacologic agents, and application of hemostatic factors. An immunosuppressed male patient with large B-cell Lymphoma and thrombocytopenia with aortic root abscess underwent root replacement surgery with a homograft. After an allergic reaction to platelet transfusion, a hematologic consult was requested, and guided transfusion was performed perioperatively. In total, six pools of washed platelets and cryoprecipitate were administered. Fresh frozen plasma (FFP) was also used after a test dose. Patients with large B-cell lymphoma typically suffer from bone marrow suppression. An individualized approach is necessary to guide transfusion in this special population. The administration of FFP as a test dose before entering the cardiopulmonary bypass may be useful in managing hemodynamic compromise in case of a reaction. Multidisciplinary management led to a successful outcome.