Ｉ型ＣＤ３６欠損症を合併した虚血性心疾患患者に対する無輸血開心術

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  • Autologous Blood Donation and Open Heart Surgery in a Patient with Ischemic Heart Disease and Type I CD 36 Deficiency

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In patients with type I CD 36 deficiency, immunization with CD 36 antigen (Naka) through pregnancy or transfusion, could produce anti-CD 36 antibody (anti-Naka), and potentially lead to platelet transfusion refractoriness or posttransfusion purpura. We report a 72-year-old woman who had no history of pregnancy or previous blood transfusions. She had been treated medically for hypertension and heart failure since the age of 65 years. Type I CD 36 deficiency was also diagnosed based on the findings of 123I-β-methyl-iodophenyl pentadecanoic acid cardiac scintigraphy. At 72 years of age, she suffered acute thromboembolism in the left external iliac artery. The thrombus was removed and a left external iliac artery to left superficial femoral artery bypass was performed without any blood transfusion. Echocardiography, left ventriculography and coronary angiography showed left ventricular aneurysm and coronary artery disease. Resection of the left ventricular aneurysm and coronary artery bypass grafting were performed without donor blood transfusion. Autotransfusion by autologous blood donation and intraoperative autologous blood transfusion was used to avoid sensitization by the CD 36 antigen through donor blood transfusion. Autotransfusion should be performed to avoid complications associated with donor blood transfusion particularly in patients with type I CD 36 deficiency.

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