Case Of Life-threatening Bleeding Research Articles

Changes over the last two decades in Hemophilia A and B management in a Tertiary Care Pediatric Centre

ObjectiveThe treatment of Hemophilia A and B has significantly evolved. Study designwe conducted a retrospective, observational study among patients with HA and HB managed in a Pediatric Hematology and Oncology Unit for almost 22 years for a total of 34 patients. ResultsUntil 2009, more than 80 % of patients were treated only on demand, while in 2022,100 % of patients with moderate and severe disease were receiving continuous prophylaxis. The median age at the start of prophylaxis passed from 10,9 to 1,65 years. In 2022, only one patient was on Standard-half-life-rFVIII, 7 patients were on Extended Half-Life (EHL)-rFVIII/rFIX and 7 patients were on Emicizumab; 1 patient was on Concizumab. The mean ABR passed from 5,7 in the period 2001–2009 to 0,8 in the period 2019–2022. We performed 106 ultrasonographic exams in 19 patients to evaluate the HEAD-US score: a percentage of 45,3 % of these exams revealed a score of 0 and the HEAD-US score resulted inferior in patients who started prophylaxis at an age below the median age at the initiation of prophylaxis. The score showed a tendency to correlate with the number of previous hemarthrosis. In our cohort, the overall prevalence of inhibitors is 0,09 among all patients, and 0,14 in severe HA/HB. 4 patients needed a Central Venous Line (CVL), and 3 patients developed at least one severe complication. Before 2017, we observed 4 cases of life-threatening bleeding in children less than 2 years old not on prophylaxis. Resultsour real-life experience reflects the changes in hemophilia management in the last two decades. In the future, other drugs are expected.

Life-threatening bleeding in patients with hemophilia (PWH): a 10-year cohort study in Dakar, Senegal

ABSTRACT Life-threatening bleeding (LTB) is one of the major complications of hemophilia with a high risk of mortality. Objective The aim of this study was to assess incidence, risk factors, treatment and outcome of LTB in Senegalese people with hemophilia (PWH). Methods We analyzed the characteristics of LTB in a cohort of 274 PWH after 10 years of follow-up. Results We included 274 patients (241 HA and 33 HB). The mean age was 16.45 years and the median age was 13 years. The mean annual bleeding rate (ABR) was 1.65 (2.83 for severe form, 1.54 for moderate form, and 1.22 for mild form). A replacement therapy with clotting factor concentrates (CFC) was administered to 217 patients (79.2%); 56 patients (20.4%) received low-dose prophylaxis (LDP). Prevalence of inhibitors was 4.7% (13/274). All patients were HIV and HCV antibody negative. We observed 31 cases of LTB in 22 patients with an incidence of 8.03%. Central nervous system (CNS) bleeds were most frequent (6.2%) and accounted for 54.8% of severe bleeding. The delay between the first signs and the emergency visit was 78.9 hours. Inhibitors were positive in one patient among those who presented LTB. These bleeding were treated with CFC in 16 patients, surgical drainage (1 patient) and electrocoagulation during gastroscopy (1 patient). Eleven patients had complete remission and two had sequelae. We reported 0.32 death per 100 person-years. CNS bleeds were the main cause (77.7%). Four patients were secondarily on LDP. We observed a significant correlation between treatment (after 2 hours) and mortality. Conclusion LTB is a serious and lethal complication in PWH in absence of early management. A good awareness of patients and their family would further reduce this incidence, especially in resources-limited countries.

A Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST

Gastrointestinal Stromal Tumours (GISTs) are rare mesenchymal tumours that are specific to GI tract. GISTs usually associated with advanced age and have a slight male preponderance. GISTs are commonly found in stomach. Jujunal GISTs are the rarest and account for about 0.1-3% of all GI tumours [1]. The most common clinical manifestation of symptomatic GISTs includes intermittent bleeding due to mucosal ulceration. Massive, life threatening gastrointestinal (GI) bleeding is a rare occurrence. We report a rare case of bleeding Jejunal GIST in a 32-year-old female who presented with haemorrhagic shock that required resuscitative laparotomy. Histopathology and immunohistochemistry confirmed the tumour to have features of GIST with clear margins and post-operative cross-sectional imaging excluded any metastatic deposits.

Life-threatening bleeding from gastric dieulafoy\u2019s lesion in a pregnant woman with hellp syndrome: a case report and literature review

BackgroundDieulafoy’s lesion (DL) is one of the rare causes of upper gastrointestional bleeding. This disease is characterized by small sub-mucosal arteriole that eroded the stomach mucosa and cause severe upper GI bleeding without obvious ulceration. The most common location is fundus area of stomach and usually affects patients over 50 years of age with multiple comorbidities.Case presentationWe report a case of life-threatening bleeding from DL during late pregnancy 31 weeks. Hemoclips were used twice through upper endoscopy with successful hemostasis. Unfortunately, she developed HELLP syndrome diagnosed 5 days after the GI bleeding was stopped. Her pregnancy had to be terminated with delivery of a premature infant. She recovered from her illness and discharged from hospital uneventfully. There is no current report in literature of DL in pregnant woman subsequently suffered HELLP syndrome.ConclusionEndoscopic hemoclip application is an effective technique in the treatment of upper GI bleeding from DL. For this patient, laparoscopic surgery or combination therapy before pregnancy may have been a suitable treatment on preventing rebleeding.

Managing reversal of direct oral anticoagulants in emergency situations. Anticoagulation Education Task Force White Paper.

Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24-7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.

Prothrombin complex concentrate for warfarin-induced bleeding in a patient with a mechanical aortic valve

Reversal of anticoagulation-induced bleeding in the perioperative period can be challenging, particularly with an unstable patient with a mechanical valve. We present a case of life-threatening bleeding successfully managed with a prothrombin complex concentrate as an alternative to fresh frozen plasma.

Life-threatening bleeding and radiologic intervention after aesthetic surgeries with minimal invasive approaches: Report of two cases

In this article, the authors report two cases of life-threatening bleeding after cosmetic surgeries that have been successfully treated with radiologic intervention. A 25-year-old female and a 35-year-old female presented at their institutions because of postoperative bleeding after intraoral mandibular angle ostectomy and endoscopic-guided trans-axillary breast augmentation, respectively. A ruptured traumatic pseudo-aneurysm of the right superficial temporal artery was diagnosed in the first case and a haematoma posterior to the right pectoralis major, due to active bleeding from a perforator of internal mammary artery, in the second case. Attempts were made to stop the haemorrhage using standard methods, but failed. Therefore, superselective microcatheter angioembolisation has been successfully performed in both the cases. At 22-month follow-up for the first case and at 12-month follow-up for the second case, the patients are asymptomatic and the cosmetic outcomes are being preserved. With radiologic intervention, the authors gained satisfactory results in the above-mentioned situations. Using this, with only local anaesthesia and the absence of incisions, a precise approach with immediate treatment to the haemorrhaging site is possible. This can be an excellent solution for arterial bleeding that is difficult to access anatomically after aesthetic surgeries, and in selected cases. Furthermore, this procedure is less disfiguring and preserves the aesthetic surgery outcomes.