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      A Case Report on the Utilization of a Hemostasis Analyzer System in the Management of a Patient With Essential Thrombocythemia

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          Abstract

          Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by persistent elevation of platelet count due to abnormal proliferation of megakaryocytes. While some cases may be asymptomatic, the condition is associated with an increased risk of complications such as thrombosis and bleeding tendencies, necessitating appropriate management tailored to individual cases. Hemostasis analyzer systems are automated analytical devices designed for comprehensive evaluation of blood coagulation function. These systems enable rapid and accurate measurement of multiple parameters, including coagulation time, platelet function, and fibrin formation, thus facilitating a holistic assessment of hemostatic function. A 76-year-old male patient presented to our hospital. At the age of 65, he received treatment for promyelocytic leukemia and achieved remission. At 75 years, he developed leukocytosis, thrombocytosis, and progressive anemia. A comprehensive examination, including bone marrow biopsy and genetic testing, revealed a JAK2 mutation, leading to the diagnosis of ET. At the age of 76 years, he complained of chest discomfort during exertion. Further investigation revealed severe aortic valve stenosis and two-vessel coronary artery disease. The patient underwent aortic valve replacement and three-vessel coronary artery bypass grafting. A hemostasis analyzer system was used to monitor coagulation function throughout the procedure. Compared with the normal range, his coagulation profile showed a tendency toward hypercoagulability. Intraoperative and postoperative transfusions were performed as required. The patient's postoperative course was uneventful without any complications related to bleeding or thrombosis.

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          Thrombocytapheresis: managing essential thrombocythemia in a surgical patient.

          A 73-year-old man presented with acute chest pain and shortness of breath suggestive of unstable angina. A detailed investigation revealed essential thrombocythemia and coronary artery pathology. With a baseline platelet count of 2,650×10(3)/μL, coronary artery bypass grafting became nearly impossible. Three therapeutic plateletpheresis procedures successfully lowered the platelet count to 367×10(3)/μL. Thereafter, surgery was performed with no complications. Although a drop and rise in platelet counts were observed postoperatively, the patient could be discharged in stable condition after 14 days. Thus, therapeutic plateletpheresis reduces platelet count rapidly in essential thrombocythemia and relieves patients of acute symptoms. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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            Essential Thrombocythemia and Cardiac Surgery: A Case Series and Review of the Literature

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              A Novel Approach to Essential Thrombocythemia and Cardiac Surgery.

              Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by persistent thrombocytosis (>450 × 109/L). Patients with ET are at risk for thrombotic or hemorrhagic complications especially during cardiovascular operations. We discuss a patient with ET requiring coronary artery bypass grafting with a presenting platelet count of 1631 × 109/L. Platelet reduction with an intraoperative autologous transfusion technique decreased the platelet count to 758 × 109/L before initiation of cardiopulmonary bypass. In addition, perioperative cangrelor therapy was administered to further limit risk of thrombotic complications. The patient had an uneventful perioperative and postoperative course.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 July 2024
                July 2024
                : 16
                : 7
                : e63787
                Affiliations
                [1 ] Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN
                Author notes
                Article
                10.7759/cureus.63787
                11297564
                39100041
                3be2c6f0-7a8d-4817-9bb2-49f63e6ba0a2
                Copyright © 2024, Nakajima et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 July 2024
                Categories
                Cardiac/Thoracic/Vascular Surgery

                aortic valve replacement,hemostasis,cardiopulmonary bypass,essential thrombocythemia,hemostasis analyzer

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