1/4. Delayed, massive bleeding as an unusual complication of laser conization. A case report.BACKGROUND: Although delayed bleeding following cervical conization is a common complication of this surgical procedure, the amount of blood loss is usually not life threatening. CASE: A 27-year-old woman underwent conization with a KTP laser for the treatment of microinvasive cervical adenocarcinoma. Eight days later the patient experienced sudden, massive genital bleeding at her workplace. The source of the bleeding was identified as a descending branch of the left uterine artery exposed to the wound surface. hemostasis was achieved completely with direct surgical ligature of the exposed blood vessel. The patient's blood loss during the course of the events was estimated to be 3.2 L, for which she received 1.4 L of packed red blood cells. She had an uneventful postoperative recovery. There was no bleeding or recurrence of the disease during 4 years of follow-up. CONCLUSION: Clinicians should be alert to the possibility of massive bleeding as a delayed surgical complication of cervical conization.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
2/4. Use of recombinant factor viia to treat life-threatening non-surgical bleeding in a post-partum patient.Ongoing bleeding from patients who have an acquired coagulopathy post-surgery is a common problem. Strategies that are available to combat this problem revolve around the replacement of coagulation factors, platelets, and red blood cells as necessary. These strategies are not always successful and a more direct approach to activating the coagulation system can be more effective and in some instances life saving. We describe the use of recombinant factor viia in a patient with ongoing post partum bleeding.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
3/4. thrombocytopenia and the risks of intraocular surgery.BACKGROUND AND OBJECTIVE: In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery. patients AND methods: A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994--1995 and 1998--1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study. RESULTS: Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail. CONCLUSIONS: The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
4/4. Use of recombinant activated factor VII (rFVIIa-NovoSeven) in the treatment of uncontrolled postsurgical hemorrhage in a patient with deep venous thrombosis and caval filter. A case report.A 37-year-old woman affected by renal insufficiency was submitted to renal transplantation from cadaver donor. After a few days she had a severe and life-threatening hemorrhage at the surgical site and a deep venous thrombosis at her lower right limb. Since anticoagulant therapy was contraindicated, a filter was inserted in the inferior vena cava. After several red blood cell, fresh plasma and platelet transfusions, and after repeated unsuccessful surgical procedures, a single dose of 70 microg/kg of body weight of recombinant activated factor VII (rFVIIa) was administered as last resource. The drug was successful in obtaining the complete and rapid resolution of the hemorrhagic episode. Despite the patient had two factors which could have favoured a thrombotic complication, e.g. deep venous thrombosis and caval filter, administration of rFVIIa did not worsen the underlying thrombotic process. rFVIIa is a new hemostatic agent that was initially used in hemophiliac patients. Later it has been successfully used in nonhemophiliac patients to treat different inherited or acquired coagulation disorders. A potential thrombogenic effect of rFVIIa was hypothesized on the basis of some clinical case reports but large controlled trials do not exist. In this case report the use of rFVIIa was successful and safe despite the concomitant presence of several thrombogenic factors.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |