THROMBOLYTIC TREATMENT CAN REDUCE SPONTANEOUS HEMOLYSIS IN IMPLANTED ROTARY PUMPS

Abstract

Introduction: From paracorporeal rotary blood pumps it is known, that even small thrombotic adhesions at the vanes or connecting joints can disturb the flow field and cause massive hemolysis. When massive spontaneous hemolysis did occur in a patient with fully implanted rotary pump, we therefore hypothesized, that thrombolytic treatment may “clean” the pump. Case report: A male patient (44 y, dilative CMP) received a Micromed® rotary pump as bridge to transplantation. Anti-coagulation was initiated with heparin and continued with Marcoumar (INR 2.5 - 3.5), antiaggregation was done with aspirine and dipyridamole. The patient recovered completely, with hemolysis typically below 5 mg/dL. After two month of assist, hemolysis increased within two days to 120 mg/dl, accompanied by hematuria and increase of serum creatinine. Therefore recombinant tissue plasminogen activator (rTPA, 15mg) was administered as venous bolus. After an intermediate decrease, hemolysis increased again, therefore a second bolus was administered, and hemolysis decreased to 10mg/dL. A second episode occurred 7 days later (fHb: 90mg/dL), after a third bolus fHb decreased immediately (< 5 mg/dL, stable since 5 weeks). No adverse effects were observed. Conclusion: Thrombolytic treatment can reduce thrombotic adhesions in miniature pumps and can be an effective procedure with acceptable risk at severe hemolysis.