An uncommon cause of postoperative bleeding

Berlot, Giorgio; Tartamella, Fabiana; Bussani, Rossana; Vassallo, Michele Claudio; Gerebizza, Sabina

doi:10.1097/mbc.0b013e328343f8d7

Cited by 4 publications

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a point of care assay, TEG can provide measurements of coagulation and fibrinolysis in 30 min. Berlot et al [7]and Zambruni et al [8] both suggested that TEG is the best method to diagnose endogenous heparin-like substances. The difference between CK-TEG R-time and CKH-TEG R-time is associated with heparin effects, although the difference cannot give a quantitative level of heparin.…”

Section: Discussionmentioning

confidence: 99%

Endogenous Heparin-Like Substances May Cause Coagulopathy in a Patient with Severe Postpartum Hemorrhage

Wang

Liu

et al. 2019

Transfus Med Hemother

View full text Add to dashboard Cite

Introduction: Postpartum hemorrhage (PPH) is associated with maternal morbidity and mortality. Accurate diagnosis of the cause of puerperal hemorrhage is as important as treatment strategies for resuscitation. We report a case of coagulation disorder caused by endogenous heparin-like substances in a PPH patient. Case Presentation: A 30-yearold woman with no medical history of bleeding disorders suffered intractable hemorrhage following spontaneous delivery in a local hospital. The patient was transferred to the department of obstetrics of a superior hospital. On arrival, the patient was found to have severe hemorrhagic anemia, hemorrhagic shock, and disseminated intravascular coagulation. Active treatments were performed, but the patient continued bleeding. Laboratory testing, performed during early treatment, revealed that all coagulation factors were below normal. The differences between CK-TEG R-time (reaction time in citrated kaolin thromboelastography assay) and CKH-TEG R-time (reaction time in citrated kaolin with heparinase thromboelastography assay) suggested the presence of heparin activity. However, the patient's family denied heparin use prior to presentation. Thus, we deduced that endogenous heparin-like substances were the main cause of the coagulopathy. After receiving treatment with protamine, the patient stopped bleeding. Meanwhile, all coagulation parameters and the TEG assay results improved. Conclusions: In this case report, TEG assay suggested the presence of heparin activity in a PPH patient, and treatment also highlighted the importance of analyzing different parameters in TEG.

show abstract

Section: Discussionmentioning

confidence: 99%