1/3. Bilateral central retinal vein occlusion in Eisenmenger syndrome.PURPOSE: To report a case of bilateral central retinal vein occlusion in a patient with Eisenmenger syndrome. methods: Case report. A 60-year-old woman with Eisenmenger syndrome secondary to a congenital ventricular septal defect presented with a 2-week history of decreased vision in both eyes. RESULTS: Ophthalmic examination revealed bilateral central retinal vein occlusion. Laboratory findings included hematocrit of 50.3% and pO(2) of 52 mm Hg while on O(2) 5 L/min per nasal cannula, despite having undergone phlebotomy 2 weeks earlier. CONCLUSION: Chronic hypoxia caused by Eisenmenger syndrome may result in polycythemia with resultant hyperviscosity and bilateral central retinal vein occlusion.- - - - - - - - - - ranking = 1keywords = phlebotomy (Clic here for more details about this article) |
2/3. Chronic alpha 1 blockade in a patient with Eisenmenger syndrome.In an 18-year-old male with Eisenmenger syndrome cyanosis and erythrocytosis were increasing. The erythrocytosis diminished following oral bunazosin and phlebotomy was not needed during the treatment. When bunazosin was stopped, the erythrocytosis increased, but when it was resumed, the erythrocytosis and general fatigue diminished.- - - - - - - - - - ranking = 1keywords = phlebotomy (Clic here for more details about this article) |
3/3. phlebotomy with iron therapy to correct the microcytic polycythemia of chronic hypoxia.patients with chronic hypoxia develop a physiologically appropriate "secondary" polycythemia that improves oxygen carrying capacity. Supplemental iron is often required to maintain this. In severe cases when hematocrit levels approach 70%, iron is withheld in order to avoid dangerously high hematocrit levels and the risks of vascular sludging due to "hyperviscosity." Some patients even require reduction of viscosity by exchange of their polycythemic blood for plasma when symptoms develop. iron deficiency with microcytic polycythemia can then develop. Management of such patients is unclear. Continued blood withdrawal will worsen the iron deficiency; iron supplementation will increase the hematocrit level and the risks of hyperviscosity. The combination of frequent phlebotomy with oral iron therapy should improve iron stores while safely maintaining a stable hematocrit level in patients with microcytic polycythemia. This combination should also have multiple beneficial effects on tissue oxygen delivery and utilization. This approach has been discussed and used for a patient with microcytic polycythemia due to Eisenmenger syndrome. While on therapy the patient's clinical symptoms decreased, and his serum iron level, hematologic indices, and treadmill tolerance tests all improved.- - - - - - - - - - ranking = 1keywords = phlebotomy (Clic here for more details about this article) |