Case report: Lifesaving therapeutic plasma exchange by cell saver in an obstetric emergency

Introduction. Abnormally high levels of triglycerides (hyperlipidemia) are often the result of a number of disorders in the body, which over time can lead to conditions such as hypothyroidism, nephrotic syndrome, diabetes, obstruction of the biliary ducts, hepatic impairment et al. The topic of how to treat the extreme hyperlipidemia has been an important discussion point in medical circles. Case report. This paper presents the case of a 33-yearold pregnant women in the 34th week of the first proper pregnancy with laboratory-verified extreme hyperlipidemia, who was brought in critical condition to the Clinical Center of Kragujevac. After the emergency cesarean section was performed, due to the general poor condition of the patient and extremely high levels of triglycerides and cholesterol, lipopheresis was indicated, which in our institution was not technically possible to treat and therefore it was necessary to find an alternative solution. Conclusion. It was shown that the application of intraoperative blood salvage can be used successfully not only in heavy bleeding during surgery, but also for cleaning the blood itself, which was clearly shown in the laboratory analysis. key words: hyperlipidemia, operative blood salvage, blood transfusion, autologous. SaŽetak Uvod. Povećane vrednosti triglicerida (hiperlipidemija) obično su posledica niza poremećaja u organizmu koji vremenom mogu dovesti do stanja poput hipotireoze, nefrotskog sindroma, dijabetesa, opstrukcije žučnih puteva, oštećenja funkcije jetre i dr. Kako lečiti ekstremnu hiperlipidemiju značajna je tema za diskusiju u medicinskim krugovima. Prikaz slučaja. U ovom radu prikazan je slučaj 33godišnje trudnice u 34. nedelji prve uredne trudnoće sa laboratorijski verifikovanom ekstremnom hiperlipidemijom, koja je u kritičnom stanju dovezena u Klinički centar Kragujevac. Nakon hitno izvršenog porođaja carskim rezom zbog opšteg lošeg stanja pacijentkinje i ekstremno visokih vrednosti triglicerida i holesterola, indikovana je lipofereza, za čiji tretman u našoj ustanovi ne postoje tehničke mogućnosti, te je bilo neophodno pronaći alternativno rešenje. Zaključak. Pokazano je da aparat za intraoperativno spasavanje krvi može biti uspešno upotrebljen ne samo kod obilnog krvarenja u toku hirurške intervencije nego i za čišćenje same krvi, što jasno pokazuju laboratorijske analize. ključne reči: hiperlipidemija, operativno spašavanje krvi, transfuzija krvi, autologna. CASE REPORT: LifESAving ThERAPEuTiC PLASmA ExChAngE by CELL SAvER in An ObSTETRiC EmERgEnCy Marija Vranes1, Zvezdana Lojpur1, Milena Todorovic2, Gordana Ostojic3, Elizabeta Ristanovic3, Bela Balint3,4 1Department for Transfusion Medicine, Clinical Center of Kragujevac, Kragujevac, Serbia 2Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia 3Military Medical Academy, Belgrade, Serbia 4Serbian Academy of Sciences and Arts, Belgrade, Serbia PRikAz SLučAjA: TERAPijSkA zAmEnA PLAzmE PuTEm AuTOLOgnE TRAnSfuzijE u AkušERSkOm uRgEnTnOm STAnju Marija Vraneš1, Zvezdana Lojpur1, Milena Todorović2, Gordana Ostojić3, Elizabeta Ristanović3, Bela Balint3,4 1Služba za transfuziju, Klinički centar Kragujevac, Kragujevac 2Klinika za hematologiju, Klinički centar Srbije, Beograd 3Vojnomedicinska akademija, Beograd 4Srpska akademija nauka i umetnosti, Beograd