A tromboelastometria identifica coagulopatia associada à insuficiência hepática e coagulação intravascular disseminada causadas por febre amarela, orientando a terapia hemostática específica: um relato de caso / Thromboelastometry identifies coagulopathy associated with liver failure and disseminated intravascular coagulation caused by yellow fever, guiding specific hemostatic therapy: a case report

RESUMO Este relato de caso detalha um caso grave de febre amarela complicada por insuficiência hepática e coagulação intravascular disseminada. A tromboelastometria foi capaz de identificar os distúrbios da coagulação e orientar o tratamento hemostático. Relatamos o caso de um homem com 23 anos de idade admitido na unidade de terapia intensiva com quadro com início abrupto de febre e dor muscular generalizada associados a insuficiência hepática e coagulação intravascular disseminada. Os resultados dos exames laboratoriais convencionais revelaram trombocitopenia, enquanto a tromboelastometria sugeriu coagulopatia com discreta hipofibrinogenemia, consumo de fatores de coagulação e, consequentemente, aumento do risco de sangramento. Diferentemente dos exames laboratoriais convencionais, a tromboelastometria identificou o distúrbio de coagulação específico e, assim, orientou o tratamento hemostático. Administraram-se concentrados de fibrinogênio e vitamina K, não sendo necessária a transfusão de qualquer componente do sangue, mesmo na presença de trombocitopenia. A tromboelastometria permitiu a identificação precoce da coagulopatia e ajudou a orientar a terapêutica hemostática. A administração de fármacos hemostáticos, incluindo concentrados de fibrinogênio e vitamina K, melhorou os parâmetros tromboelastométricos, com correção do transtorno da coagulação. Não se realizou transfusão de hemocomponentes, e não ocorreu qualquer sangramento.

Abstract This case report a severe case of yellow fever complicated by liver failure and disseminated intravascular coagulation. Thromboelastometry was capable of identifying clotting disorders and guiding hemostatic therapy. We report the case of a 23-year-old male admitted to the Intensive Care Unit with sudden onset of fever, generalized muscle pain associated with liver failure, and disseminated intravascular coagulation. The results of conventional laboratory tests showed thrombocytopenia, whereas thromboelastometry suggested coagulopathy with slight hypofibrinogenemia, clotting factor consumption, and, consequently, an increased risk of bleeding. Unlike conventional laboratory tests, thromboelastometry identified the specific coagulation disorder and thereby guided hemostatic therapy. Both fibrinogen concentrates and vitamin K were administered, and no blood component transfusion was required, even in the presence of thrombocytopenia. Administration of hemostatic drugs, including fibrinogen concentrate and vitamin K, improved thromboelastometric parameters, correcting the complex coagulation disorder. Blood component transfusion was not performed, and there was no bleeding.

Prognosis of acute fulminant hepatic failure. To assess the causes and prognosis of acute fulminant hepatic failure in patients attending medical Unit I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur

Acute fulminant hepatic failure [ALF] is a medical emergency and associated with high mortality rate. Its etiology shows considerable geographical variations. The viral causes are the most common in our region, [whilst acetaminophen [Paracetamol] induced hepatotoxicity forms the most common precipitant in many developed countries]. To assess the causes and prognosis of acute fulminant hepatic failure in patients attending medical unit I, Ghulam mohammad Mahar Medical college hospital, Sukkur. A cross-sectional study. Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. From January 2010 to July 2011. a total one hundred twenty [120] patients of ALF were studied during the study period to evaluate the causes and prognosis. Those patients who were admitted during the study period were included in the study. The selected patients presented with jaundice and hepatic encephalopathy of varying grades. Almost all the cases the causative agents were viruses. Among theses, the hepatitis E virus [HEV] was the top most causative agent followed by hepatitis B virus [HBV] in this study. Despite good effort of conservative treatment, the mortality rate was 77.5%. The mortality rate was higher in grade-III and grade-IV encephalopathy patients, whereas the prognosis is better in grade-1 and grade-II encephalopathy patients