ABSTRACT 218

Abstract

Background and aims: Thromboembolic events are frequently discussed in recent years, for congenital factors increase the risk of thrombosis. Protein C and S deficiencies, antithrombin failure, prothrombin 20210A mutation, activated protein C resistance are the considerable causes leading to hereditary thrombophilia. Here, a young infant who developed an unexpected necrotic hematoma was presented. Methods: CASE A 37-day old female patient with afebrile seizure was admitted. She had an uneventful perinatal period with first degree consanguinity with maternal history of two abortions. Her examination revealed normal between brief convulsive episodes. Complete blood count, biochemical tests, lumbar puncture findings and metabolic studies were normal. She was commenced phenobarbital treatment after hospitalization. EEG revealed no pathologic finding. MRI of brain was unremarkable. On follow-up, he had no seizure of 36 hours after phenobarbital treatment. However, she developed necrotic hematoma on the right hand around the catheter entrance hole while she was only taking liquid treatment. The necrotic hematoma in conjunction with maternal history was considered a thromboembolic event. Thus, factor levels, bleeding parameter, APC-Antithrombin III level, cardiolipin and phospholipid antibody levels have been studied. APC resistance was 55.2 sec. (N>120sec.). Low molecular weight heparin was started. Conclusions: Extravasations of emergency drugs such as calcium and dopamine may develop necrosis while maintenance therapy is not expected to. In the presence of such catheter problems, thrombophilia should be considered. Activated protein C resistance is one of the most important disorders in inherited thrombophilia. Anti-thrombotic prophylaxis may be started to the patients.