deamino-arginine-vasopressin and Waldenstrom-Macroglobulinemia

Of 150 consecutive patients who underwent dacryocystorhinostomy, postoperative hemorrhage requiring treatment occurred in 2 patients, both of whom had endogenous platelet dysfunction without thrombocytopenia. The first patient had macroglobulinemia, and the second patient had congenital platelet hypofunction. Prophylactic 1-deamino-8-D-arginine vasopressin (desmopressin; DDAVP) was used successfully to decrease intraoperative bleeding in the second patient. Of the 15 patients with exogenous platelet dysfunction secondary to the use of aspirin or nonsteroidal anti-inflammatory agents within 1 week of operation, none had hemorrhaging. Dacryocystorhinostomy should be undertaken cautiously and with hematologic consultation in patients with blood dyscrasias.

Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Platelet Disorders; Dacryocystitis; Dacryocystorhinostomy; Deamino Arginine Vasopressin; Epistaxis; Female; Hemorrhage; Humans; Lacrimal Apparatus Diseases; Male; Nasolacrimal Duct; Postoperative Complications; Waldenstrom Macroglobulinemia

A 73-year old patient suffering from IgM-paraproteinemia, plasma hyperviscosity, and acquired v. Willebrand's disease developed two consecutive bleeding episodes. He was treated by double-bag plasmapheresis and double-bag plasmapheresis combined with DDAVP. This combined therapy was superior to plasmapheresis alone, since bleeding ultimately stopped and did not reoccur. Thus, labour and expense of large volume plasma exchange and the costs of F VIII therapy could be prevented.

Topics: Aged; Blood Viscosity; Combined Modality Therapy; Deamino Arginine Vasopressin; Hemorrhagic Disorders; Humans; Male; Plasmapheresis; von Willebrand Diseases; Waldenstrom Macroglobulinemia