Clinical Assessment of Severe Hemolysis in a 15-Month-Old Infant With Tetralogy of Fallot Undergoing Surgical Repair During Cardiopulmonary Bypass: A Case Report

Document Type : Case Report


1 Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Anesthesiology Department Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran.


Some degrees of hemolysis are probable in pediatric patients receiving cardiopulmonary bypass. Nonetheless, severe hemolysis, even in premature infants undergoing cardiac surgeries, is rare. When hemolysis happens in a neonate or infant receiving cardiopulmonary bypass, numerous causes, including erythrocyte membrane defects, hemoglobinopathies, iso-immunization, undiagnosed enzyme abnormalities, and acquired conditions such as sepsis or drug interactions, should be considered. Urine discoloration may be considered a hemolytic reaction secondary to blood transfusion; still, in mild degrees of hemolysis due to mechanical trauma, this discoloration may not be noticed. One type of acute hemolytic reaction is immunological, which may happen secondary to the interaction between the recipient’s antibodies and the donor’s antigens, although most severe cases of hemolytic anemia are secondary to ABO incompatibility
In this case report, we describe a 15-month-old infant undergoing surgical repair for tetralogy of Fallot, who developed hemolysis during cardiopulmonary bypass. We also discuss the case’s diagnostic workup and therapeutic management. (Iranian Heart Journal 2022; 23(3): 144-149)


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