Woman with a Bleeding Diathesis

The Medicine Forum

Kim MD, PGY-3, Bo¹ 

[1] Thomas Jefferson UniversityThomas Jefferson UniversityThomas Jefferson University

关键词: Woman;    Bleeding Diathesis;    Thomas jefferson university;    department of medicine;    the medicine forum;    philadelphia;   

DOI  :  

学科分类：医学（综合）

来源: Thomas Jefferson University

【 摘 要 】

61 year-old Indian female with history of hypercholesterolemiapresents to an outside hospital (OSH) withworsening vaginal bleeding, hematochezia, nausea, andvomiting starting three days prior to admission. Patientalso had a global persistent headache for approximately24 hours at the time of admission. Otherwise, the patientdenied any fever, chills, abdominal pain, or trauma. Thepatient noted no previous episodes of bleeding or easybruising in her past. She notes that her menstrual periodswere always regular and not subjectively heavy. Lastmenstrual period was 10 years ago. Patient has had twopregnancies in her obstetric history for which shedelivered vaginally without bleeding complications. Thepatient denied recent antibiotic use. She had no changein diet and no prior transfusions. At the OSH, thepatient was noted to be orthostatic at presentation withmild tachycardia but was stabilized with intravenousfluids and transfusions of packed red cells. Patient’snausea and vomiting resolved with antiemetics at theOSH. Nasogastric lavage was negative for blood.Laboratory results revealed patient to have markedlyelevated prothrombin time (PT) and activated partialthromboplastin time (aPTT) with an INR greater than20. The patient was initially treated with fresh frozenplasma (FFP) and high doses of vitamin K. The patientdenied any warfarin use and she did not know anyonecurrently on the medication. CT scan of the head showedleft subdural hematoma without midline shift orhydrocephalus. The patient was immediately transferredto the Jefferson Neurosurgical service. The patient wassubsequently deemed a poor surgical candidate and wascontinued on supportive treatment with blood productsand vitamin K. At time of transfer to the medicineservice, the patient developed respiratory distress withsevere hypoxia requiring intubation. The patient wasadmitted to the intensive care unit (ICU) for ventilatordependentrespiratory failure secondary to TransfusionRelated Acute Lung Injury (TRALI). After five days, thepatient was extubated and transferred to the medicinefloor team in stable condition for further managementof her bleeding diathesis.

【 授权许可】

Unknown