Assuntos
Asparaginase/uso terapêutico , Erwinia/enzimologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adulto , Asparaginase/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis , Estudos Retrospectivos , Trombose/induzido quimicamente , Adulto JovemRESUMO
Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatment resulting in a severe acquired thrombophilic condition with an associated mortality of about 10 %. We report the first case of successful urgent liver transplantation (LT) in a patient with end-stage liver disease due to a Budd-Chiari syndrome, portal vein thrombosis and pulmonary embolism due to acquired thrombophilia associated to polycythemia vera carrying JAK2V617F gene mutation and HIT in the acute phase. Lepirudin was used to provide anticoagulation in the LT perioperative period that was performed without haemorrhagic and thrombotic complications despite the donor received heparin during liver explantation.
Assuntos
Anticoagulantes/efeitos adversos , Síndrome de Budd-Chiari , Heparina/efeitos adversos , Janus Quinase 2/genética , Transplante de Fígado , Mutação de Sentido Incorreto , Policitemia Vera , Embolia Pulmonar , Trombocitopenia , Trombose Venosa , Substituição de Aminoácidos , Anticoagulantes/administração & dosagem , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/enzimologia , Síndrome de Budd-Chiari/genética , Síndrome de Budd-Chiari/cirurgia , Feminino , Heparina/administração & dosagem , Humanos , Pessoa de Meia-Idade , Policitemia Vera/complicações , Policitemia Vera/enzimologia , Policitemia Vera/genética , Policitemia Vera/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/enzimologia , Embolia Pulmonar/genética , Embolia Pulmonar/cirurgia , Trombocitopenia/induzido quimicamente , Trombocitopenia/enzimologia , Trombocitopenia/cirurgia , Trombose Venosa/complicações , Trombose Venosa/enzimologia , Trombose Venosa/genética , Trombose Venosa/cirurgiaRESUMO
Massive bleeding accounts for more than 50% of all trauma-related deaths within the first 48h following hospital admission and it can significantly raise the mortality rate of any kind of surgery. Despite this great clinical relevance, evidence on the management of massive bleeding is surprisingly scarce, and its treatment is often based on empirical grounds. Successful treatment of massive haemorrhage depends on better understanding of the associated physiological changes as well as on good team work among the different specialists involved in the management of such a complex condition.
Assuntos
Hemorragia/metabolismo , Hemorragia/fisiopatologia , Hemorragia/terapia , Feminino , Hemorragia/mortalidade , Humanos , Masculino , Fatores de Tempo , Ferimentos e Lesões/metabolismo , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapiaRESUMO
Massive bleeding is a key issue in the treatment of trauma and surgery. It does in fact account for more than 50% of all trauma-related deaths within the first 48 h following hospital admission, and it can significantly raise the mortality rate of any kind of surgery. Despite this great clinical relevance, evidence on the management of massive bleeding is surprisingly scarce, and its treatment is often based on empirical grounds. Successful treatment of massive haemorrhage depends on better understanding of the associated physiological changes as well as on good team work between the different specialists involved in the management of such a complex condition. The aim of this article is to provide an overview of the pathophysiology as well as of current treatment options of such a condition, including the new concept of "damage control resuscitation", which integrates permissive hypotension, haemostatic resuscitation and damage control surgery.