Abstract
Chronic myelomonocytic leukemia (CMMoL) is an atypical myeloproliferative disease which may cause acute leukemoid reaction or progress to leukemic transformation after bone marrow stress, when it can be fatal after cardiovascular surgery. An 86-year-old man with hypertension, chronic thrombocytopenia and mild anemia was admitted with an abdominal aortic aneurysm. Open surgery was chosen because he was in good general condition and the shape of the aneurysm was not suitable for endovascular repair. We performed a Y-graft replacement under general anesthesia and epidural anesthesia. Because of the complex shape of the aneurysm, the operation took long time, but was completed without complications. However, extreme leukocytosis, up to 100,000 /ul was seen from an early postoperative period. Bone marrow examinations were carried out which revealed CMMoL. He developed respiratory failure and died due to multiple organ failure on the 2nd postoperative day. In retrospect, perhaps we should have chosen treatment with a lower possibility of infestation such as endovascular repair, and this should be considered if preoperatively the patient has CMMoL.
