ABSTRACT
Rectus sheath hematoma is a rare complication of anticoagulant therapy. We have described the case of a 78-year-old woman with unstable angina who developed a life-threatening rectus sheath hematoma during treatment with antiplatelet drugs and enoxaparin. The patient had underlying diseases of hypertension and triple vessels disease status post coronary artery bypass graft. She was admitted initially with an asthmatic attack. Three days later, she developed unstable angina and thus received aspirin, clopidogrel, and enoxaparin. After the fifth dose of enoxaparin, she developed progressive suprapubic pain with a newly palpable mass, anemia, hypotension, and oliguria. Abdominal computed tomography revealed a rectus sheath hematoma sized 15 cm., (about 2,000 mL by volume). Her coagulogram was normal. Despite rapid fluid resuscitation, packed red cell transfusion (1,300 mL), platelet transfusion, and protamine sulfate injection, the patient’s hemodynamic status remained unstable. Finally recombinant activated factor VII (rFVIIa) injection improved her hemodynamic status and stabilized her hemoglobin level without a thrombotic complication. This case report provides evidence of the benefit of rFVIIa use as a part of the treatment of refractory bleeding from enoxaparin.
ABSTRACT
Objective: This study aims to report the HPLC patterns of urine porphyrin intermediates from Thai patients with various types of porphyrias in supporting the clinical diagnosis. Methods: A reverse phase HPLC method using kit reagents, was used to measure porphyrin intermediates in the urine of control subjects and patients with various types of porphyrias. Results: 22 control subjects showed very low levels of all urine porphyrin intermediates whereas 11 porphyriatic patients had increases of some specific isomers varying among each type of the disease. The results from 6 porphyria cutanea tarda (PCT) patients: marked increase of uroporphyrin and slight increase of the other porphyrin intermediates, 2 congenital erythropoietic porphyria (CEP), high elevation of uroporphyrin and coproporphyrin I – III ratio with slight increase of pentaporphyrin, 2 variegate porphyria (VP), marked increase of only coproporphyrin III and 1 acute intermittent porphyria (AIP) (non acute form), high increase of coproporphyrinIII with mild increase of ALA, PBG, uroporphyrin, and coproporphyrin I. Conclusion: The HPLC could provide data essential for differentiating common types of porphyrias in Thai patients, PCT, CEP, VP and AIP. Clinical findings of the patients and urine screening test for increased porphyrins were also helpful for the definite diagnosis.