RESUMO
A 30-year-old male patient presented with Glanzmann's thrombasthenia and mitral valve prolapse. He was in acute decompensated congestive heart failure due to severe mitral and tricuspid regurgitation. After his cardiac failure had been stabilized, the patient was subjected to mitral and tricuspid valve repair. His transfusion requirements were guided by thrombelastography and his bleeding disorder was managed by infusing single donor plasmapheresed platelet transfusions in the perioperative period. The patient underwent surgery uneventfully.
Assuntos
Ponte Cardiopulmonar/métodos , Valva Mitral/cirurgia , Trombastenia/complicações , Trombastenia/terapia , Adulto , Transfusão de Sangue , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/cirurgia , Transfusão de Plaquetas , Trombastenia/diagnóstico por imagem , Tromboelastografia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagemRESUMO
A 33-year-old man with Glanzmann thrombasthenia, enduring retractable melena, and with an active upper gastrointestinal bleeding (GIB) of unknown origin lasting intermittently for 6 months, was admitted. Abdominal ultrasound and computed tomography were not diagnostic. The patient underwent upper gastrointestinal endoscopy twice, both of which showed blood issuing forth from ampulla of vater and possible diagnoses of bleeding from papilla/hematobilia or hemosuccus pancreaticus were suspected. Digital subtraction angiography of celiac/superior mesenteric arteries was unremarkable. In GIB scintigraphy, a focus of activity appeared in the epigastric area early in the study (arrow), intensity of which increased gradually. Exploratory laparatomy confirmed the diagnosis of hemosuccus pancreaticus. Although the patient was doing well for few weeks after the surgery, he died 3 months later after an acute episode of severe GIB.
Assuntos
Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/diagnóstico por imagem , Pancreatopatias/complicações , Pancreatopatias/diagnóstico por imagem , Trombastenia/complicações , Trombastenia/diagnóstico por imagem , Adulto , Humanos , Masculino , CintilografiaRESUMO
Characteristics of intraocular bleeding and its management in association with blood dyscrasias are discussed. We present a patient with massive bilateral choroidal hemorrhage secondary to Glanzmann's syndrome. Magnetic resonance imaging and ultrasonographic findings were ordered. During the clinical course, bilateral intravitreal hemorrhage and tractional retinal detachment occurred. Left pars plana vitrectomy was performed under general anaesthesia. The procedure was unsuccessful because of intraoperative uncontrolled bleeding.