Perioperative Management of a Patient With CD36 Deficiency Undergoing Urgent Cardiac Surgery

Abstract

CD36 (also known as the Nak antigen) is a multi-ligand scavenger receptor expressed on many cell types, such as platelets and monocytes. CD36 deficiency was first reported in 1989 in Japanese patients with platelet transfusion refractoriness (PTR). This condition is classified into the following 2 types: type 1 deficiency involves the loss of CD36 in many cell types, including monocytes, macrophages, and platelets, whereas type 2 deficiency involves the loss of CD36 in only platelets. In the Japanese population, type 1 and type 2 deficiencies are more common than that in Western countries, with a prevalence of 0.56% to 1% and 3% to 11%, respectively. 1 Morishita K Wakamoto S Miyazaki T et al. Life-threatening adverse reaction followed by thrombocytopenia after passive transfusion of fresh frozen plasma containing anti-CD36 (Nak) isoantibody. Transfusion. 2005; 45: 803-806 Crossref PubMed Scopus (24) Google Scholar CD36 immunization via blood transfusion or pregnancy is a major concern in patients with type 1 deficiency, and it results in the development of anti-CD36 isoantibody, causing PTR and post-transfusion purpura in subsequent platelet transfusions. 2 Saw CL Szykoluk H Curtis BR et al. Two cases of platelet transfusion refractoriness associated with anti-CD36. Transfusion. 2010; 50: 2638-2642 Crossref PubMed Scopus (13) Google Scholar ,3 Bierling P Godeau B Fromont P et al. Posttransfusion purpura-like syndrome associated with CD36 (Naka) isoimmunization. Transfusion. 1995; 35: 777-782 Crossref PubMed Scopus (39) Google Scholar Furthermore, type 1 deficiency is associated with atherosclerosis, 4 Febbraio M Hajjar DP Silverstein RL. CD36: A class B scavenger receptor involved in angiogenesis, atherosclerosis, inflammation, and lipid metabolism. J Clin Invest. 2001; 108: 785-791 Crossref PubMed Scopus (913) Google Scholar glycolipid metabolism, 5 Miyaoka K Kuwasako T Hirano K et al. CD36 deficiency associated with insulin resistance. Lancet. 2001; 357: 686-687 Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar and cardiomyopathy. 6 Kushiro T Saito F Kusama J et al. Takotsubo-shaped cardiomyopathy with type I CD36 deficiency. Heart Vessels. 2005; 20: 123-125 Crossref PubMed Scopus (22) Google Scholar As CD36 is involved in free fatty acid uptake, fatty acid oxidation is replaced with glucose uptake in the CD36-deficient myocardium, which affects myocardial remodeling. 7 Schulze PC Drosatos K Goldberg IJ. Lipid use and misuse by the heart. Circ Res. 2016; 118: 1736-1751 Crossref PubMed Scopus (150) Google Scholar ,8 Fukuchi K Nozaki S Yoshizumi T et al. Enhanced myocardial glucose use in patients with a deficiency in long-chain fatty acid transport (CD36 deficiency). J Nucl Med. 1999; 40: 239-243 PubMed Google Scholar Therefore, type 1 CD36-deficient patients without prior anti-CD36 alloimmunization may require careful attention during perioperative management, especially blood management, when undergoing cardiac surgery. However, there is a paucity of data pertaining to these points. In this report, the authors describe a case of exertional angina requiring urgent coronary artery bypass grafting (CABG), wherein the diagnosis of type 1 CD36 deficiency was confirmed immediately before the cardiac surgery. Written informed consent was obtained from the patient for the publication of this case report.