Coronary artery bypass grafting in a patient with polycythaemia rubra vera - a rare indication with a spectrum of complication: a case report

Jamal Al-Fadhli,Fahad Al-Shammari,Ahmed Al-Duaij,Nael Al-Sarraf

doi:10.4076/1757-1626-2-8126

Jamal Al-Fadhli, Fahad Al-Shammari + Show 2 more

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https://doi.org/10.4076/1757-1626-2-8126

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Journal: Cases Journal	Publication Date: Jan 1, 2009
Citations: 7	License type: cc-by

Affiliation: Chest Diseases Hospital

Abstract

Coronary artery bypass surgery for coronary artery thrombosis in patients with polycythaemia rubra vera has been rarely described. The main issue with such patients is their risk of both bleeding and thrombosis and as such the ideal postoperative management of such cases is unknown. Hereby, we describe a case of a 62-year-old man with polycythaemia rubra vera who underwent coronary artery bypass surgery. Although his initial postoperative course was complicated, his long-term outcome was good.

Highlights

We describe a case of a 62-year-old man with polycythaemia rubra vera who underwent coronary artery bypass surgery
Polycythaemia rubra vera is a chronic myeloproliferative disorder that is characterized by excessive red blood cell production and unlike other forms of polycythaemia, it can cause both bleeding and thrombosis in the same patient
Polycythaemia rubra vera (PRV) is a chronic myeloproliferative disease characterized by excessive red blood cell production and in 50% of patients proliferation of all cell lines

Summary

Introduction

Polycythaemia rubra vera is a chronic myeloproliferative disorder that is characterized by excessive red blood cell production and unlike other forms of polycythaemia, it can cause both bleeding and thrombosis in the same patient. Case presentation A 62-year-old Middle Eastern man was admitted electively for coronary artery bypass graft (CABG) for ischemic heart disease and ongoing angina (Canadian cardiovascular society class III symptom) despite maximal medical therapy. His past history included non-insulin dependent diabetes mellitus, chronic obstructive pulmonary disease, hypertension and hyperlipidaemia. He remained in a stable condition until his 4th postoperative day when he started spiking fevers and developed left sided pleural effusion His renal function remained normal but his white blood cell count increased to 20 × 109/L (normal range 4.2-9.1 × 109 /L) with an increased platelet count to 605 × 109/L (normal range 140-400 × 109/L). On follow-up in our clinic, both his kidney function and platelet counts returned to normal

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