Abstract
A 3-year-old girl underwent radical operation for common A-V canal with the aid of extracorporeal circulation. Hematological and serological tests prior to the operation gave normal results. After cessation of extracorporeal circulation which lasted for 276 minutes, hemodynamics was stable. However, plasma free hemoglobin increased up to 248mg/dl on the next day. Hemoglobinuria was continuously seen for a few days. From anemia, thrombocytopenia, hyperbilirubinemia and fragmentation of erythrocyte, DIC was suggested. Heparin and aprotinin were given intravenously. Besides these drugs human plasma haptoglobin which combines with free hemoglobin in plasma was given for prevention of acute renal failure. The patient was treated with 350ml of blood, 6000 unit of heparin, 1.8 million unit of aprotinin, and 400ml of haptoglobin by the fifth postoperative day. After administration of these drugs, hemoglobinuria disappeared and plasma free hemoglobin decreased. No renal complication occurred. In two weeks after operation, serological findings gave normal results. The patient returned home after three months.
Open-heart surgery with extracorporeal circulation is one of the causes of DIC and usually heparin is used for therapy. In our case, administration of aprotinin and haptoglobin had a good effect on improvement of this syndrome.
