RESUMEN
The experience of treatment of 366 patients with haemophilia who were urgently hospitalized in hеmatological Scientific Center over the last 10 years is presented in the article. There were 114 (31.1%) patients with acute diseases of abdominal cavity organs, 150 (41%) patients with bleeding from upper gastrointestinal tract, 102 (27.9%) patients with acute hematomas of retroperitoneal space. Urgent operations were performed in 48 (22.2%) patients who were hospitalized with clinical symptoms of acute abdomen syndrome. It was developed the criteria of diagnosis and choice of treatment tactic on the basis of the received results. Application of presented algorithms led to improve the quality of urgent surgical care to patients with haemophilia.
Asunto(s)
Abdomen Agudo , Cavidad Abdominal/cirugía , Hemorragia Gastrointestinal , Hematoma , Hemofilia A/complicaciones , Hemostasis Quirúrgica/métodos , Abdomen Agudo/diagnóstico , Abdomen Agudo/etiología , Abdomen Agudo/fisiopatología , Abdomen Agudo/cirugía , Cavidad Abdominal/patología , Cavidad Abdominal/fisiopatología , Adulto , Algoritmos , Atención Ambulatoria/métodos , Atención Ambulatoria/normas , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Hematoma/diagnóstico , Hematoma/etiología , Hematoma/cirugía , Hemostáticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Mejoramiento de la Calidad , Tomografía Computarizada por Rayos XRESUMEN
A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.