A 54-Year-Old Woman With Acute Airway Obstruction

Hendricks, Mark V.; Hendricks, Linda K.; Davis, Watson

doi:10.1378/chest.122.1.348

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…One of the most important points in hemophilia management is maintaining the airway under appropriate hemostatic therapy. Ten case reports in the last 20 years discuss airway obstruction secondary to tongue and/or retropharyngeal hemorrhage in patients with hemophilia who required airway maintenance by intubation or tracheotomy [4–13]. Five of the 10 patients required tracheotomy, 4 of the 10 patients suffered failed intubation and required emergency cricothyrotomy, and 1 of the 10 patients died.…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors

et al. 2019

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Patient: Male, 71 Final Diagnosis: Hemophilia A Symptoms: Dysarthria • dysphagia • dyspnea Medication: — Clinical Procedure: Cricothyrotomy • tracheotomy Specialty: Hematology Objective: Unusual clinical course Background: Massive tongue hemorrhage in patients with hemophilia is a medical emergency because it can lead to airway obstruction. However, managing bleeding in patients with inhibitors is more difficult than in patients without inhibitors. We report a case of life-threatening massive tongue and retropharyngeal hematoma in a patient with hemophilia A who had inhibitors. Case Report: The patient was a 71-year-old man with severe hemophilia A with high-responding inhibitors. He was admitted to our hospital with dysarthria and dysphagia secondary to a massive tongue hematoma. Although bypassing therapy was started immediately after admission, he rapidly developed an airway obstruction and cardiopulmonary arrest secondary to suffocation. Cardiopulmonary resuscitation and surgical cricothyrotomy were performed, which restored his pulse and breathing. On day 5 of hospitalization, he underwent tracheotomy under inhibitor-neutralizing therapy, and we began emicizumab on day 19 of hospitalization to prevent further bleeding events. He recovered and was transferred to another hospital for rehabilitation on day 64 of hospitalization. Conclusions: Because tongue hematomas progress dramatically within a few days, prompt airway maintenance by tracheotomy under appropriate hemostatic therapy must be considered. Furthermore, emicizumab induction after primary hemostasis prevents further bleeding. We suggest that initiating emicizumab therapy is a good choice to prevent further bleeding after critical bleeding events if the patient has not received the drug previously.

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Section: Discussionmentioning

confidence: 99%

Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors

et al. 2019

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“…1), muscles or other soft tissues, or mucous membranes of the nares or gastrointestinal or genitourinary tracts, but hemarthrosis, a common manifestation of congenital hemophilia, is rare in the setting of AH [13,17]. Retropharyngeal and retroperitoneal bleeding may also occur [14,18,19]. Intracranial hemorrhage is a rare but potentially catastrophic manifestation of AH [7,20].…”

Section: Epidemiology and Clinical Presentation Of Acquired Hemophiliamentioning

confidence: 99%

“…In addition to the hemorrhage itself, other serious complications of AH-related bleeding may occur. For example, retropharyngeal hemorrhage may threaten airway patency, and intramuscular bleeding may produce a compartment syndrome with neurovascular compromise [7,18,19].…”

Section: Epidemiology and Clinical Presentation Of Acquired Hemophiliamentioning

confidence: 99%

Acquired hemophilia: a rare but life-threatening potential cause of bleeding in the intensive care unit

2011

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Recognition of acquired hemophilia presents a clinical challenge, given the rarity of this condition, a general lack of familiarity with acquired hemophilia, and the potential for confusion with other more common causes of bleeding in the intensive care unit. Nevertheless, there are sentinel clinical and laboratory findings that should raise suspicion of this diagnosis. The treatment of acquired hemophilia is a multi-step, physiologically focused process aimed at controlling both active and recurrent bleeding. Therefore, prompt diagnosis is central to prognosis. Consultation with a hematologist may facilitate efficient diagnosis and management.

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A throttled hemophilic who died due to choking

Wankhede

2007

Forensic Science International

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A 54-Year-Old Woman With Acute Airway Obstruction

Cited by 5 publications

References 5 publications

Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors

Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors

Acquired hemophilia: a rare but life-threatening potential cause of bleeding in the intensive care unit

A throttled hemophilic who died due to choking

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