Paroxysmal nocturnal hemoglobinuria: A red clot syndrome

Jeffrey D. Crawford, Victor W. Wong, Thomas G. Deloughery, Erica L. Mitchell, Timothy K. Liem, Gregory J. Landry, Amir F. Azarbal, Gregory L. Moneta

Research output: Contribution to journalArticle

Abstract

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, nonmalignant disorder of hematopoietic stem cells characterized by hemolysis, diminished hematopoiesis, and thrombophilia. We describe a 65-year-old woman with known PNH and peripheral arterial disease who presented with critical limb ischemia and a nonhealing left foot ulcer. She underwent surgical bypass of a diffusely diseased left superficial femoral artery with autologous reversed saphenous vein graft. Her postoperative course was complicated by wound sepsis and PNH exacerbation with resultant graft thrombosis requiring an above-knee amputation. This case highlights several key concepts relevant to the management of vascular surgery patients with PNH: (1) their predisposition for arterial and venous thrombosis; (2) hypercoagulability despite standard anticoagulation regimens; (3) the role of eculizumab (a monoclonal antibody that inhibits complement activation used to treat PNH) in reducing thrombotic complications and hemolysis; and (4) complications associated with the immunosuppressive effects of eculizumab. We recommend careful monitoring of hemolysis and immunosuppression, aggressive anticoagulation, frequent graft surveillance, and early consultation with hematology.

Original languageEnglish (US)
Pages (from-to)122.e5-122.e10
JournalAnnals of Vascular Surgery
Volume28
Issue number1
DOIs
StatePublished - Jan 2014

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Paroxysmal nocturnal hemoglobinuria: A red clot syndrome'. Together they form a unique fingerprint.

Cite this