Sudden cardiovascular collapse after platelet transfusion during liver transplantation: flat-line thromboelastometry and inferred pulmonary thromboembolism: A case report
Anesthesia and Pain Medicine
; : 295-300, 2015.
Article
em Ko
| WPRIM
| ID: wpr-149863
Biblioteca responsável:
WPRO
ABSTRACT
Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.
Palavras-chave
Texto completo:
1
Índice:
WPRIM
Assunto principal:
Embolia Pulmonar
/
Choque
/
Tromboelastografia
/
Trombocitopenia
/
Remoção de Componentes Sanguíneos
/
Plaquetas
/
Pressão Sanguínea
/
Mortalidade
/
Transplante de Fígado
/
Reanimação Cardiopulmonar
Tipo de estudo:
Prognostic_studies
Limite:
Female
/
Humans
Idioma:
Ko
Revista:
Anesthesia and Pain Medicine
Ano de publicação:
2015
Tipo de documento:
Article