RESUMO
We report the case of a patient who was initially presented with ischemic priapism to the emergency department. He was treated with adrenaline intracavernous injections and aspiration with irrigation of the corpora cavernosa and distal shunt. In the postoperative period, anemia, basophilia, eosinophilia, thrombocytosis and hyperleukocytosis were detected. The patient was subsequently diagnosed with chronic myeloid leukemia. Priapism is a rare manifestation of chronic myeloid leukemia (≤ 3%) and occurs mostly due to hyperleukocytosis, resulting in thrombus formation and corporal venous outflow obstruction. Priapism occurring in any setting is considered as a medical emergency that requires immediate local therapy because of resulting irreversible cell damage and fibrosis if not treated within the first 24-48 h.
RESUMO
Describir el manejo médico de tipo hemostático durante el pre, trans y posoperatorio de pacientes con hemoflia y enfermedad de von Willebrand. Materiales y métodos: serie de casos de pacientes diagnosticados con hemoflia A, B, enfermedad de von Willebrand y défcit de factor VII de enero 1993 a junio 2009 en el Hospital de San José, Bogotá DC. Resultados: 35 cirugías programadas de diferentes especialidades en 28 pacientes (4 mujeres y 24 hombres). Para aquellos con hemoflia A y B el objetivo en término de nivel hemostático para procedimientos ortopédicos fue: el día uno 100%, del dos al cinco 80% y de seis hasta el quince 58%; en cirugía general para el día uno 100%, del dos al cinco 74% y del seis en adelante 60%; en procedimientos odontológicos el día uno el factor se corrigió en promedio al 85% y del dos al cinco al 65%. Los pacientes con enfermedad de von Willebrand se manejaron con dosis de 50 UI/k cada 8 a 24 horas. Se presentaron tres infecciones y no hubo ningún fallecimiento. Conclusiones: el Hospital de San José tiene gran experiencia en la realización de procedimientos quirúrgicos programados en pacientes con hemoflia A y B y enfermedad de von Willebrand, los cuales a lo largo de estos 16 años han sido realizados con éxito y baja tasa de complicaciones.
To describe haemostatic management of patients with hemophilia and von Willebrand disease before, during and after surgery. Materials and Methods: case series of patients diagnosed with hemophilia A, B, von Willebrand disease and factor VII defciency, from January 1993 to June 2009 at Hospital de San José, Bogotá DC. Results: 35 scheduled surgeries of various specialties in 28 patients (4 females, 24 males). For those with hemophilia A and B the objective in terms of level of haemostasis in orthopedic procedures was: on day one 100%, from day two to fve: 74% and day 6 and so on: 60%; in dental procedures, on day one the factor was corrected an average of 85% and from day two to fve: 65%. Patients with Von Willebrand disease were managed with a 50 IU/k dose every 8 to 24 hours. There were 3 cases of infection and no deaths occurred. Conclusions: Hospital de San José has gained a vast experience in conducting scheduled surgical procedures in patients with hemophilia A, B and von Willebrand disease. These patients have been managed successfully during these 16 years with a low complication rate.
