Sudden cardiovascular collapse after platelet transfusion during liver transplantation: flat-line thromboelastometry and inferred pulmonary thromboembolism: A case report
Anesthesia and Pain Medicine
;
: 295-300, 2015.
Article
in Korean
| WPRIM
| ID: wpr-149863
ABSTRACT
Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pulmonary Embolism
/
Shock
/
Thrombelastography
/
Thrombocytopenia
/
Blood Component Removal
/
Blood Platelets
/
Blood Pressure
/
Mortality
/
Liver Transplantation
/
Cardiopulmonary Resuscitation
Type of study:
Prognostic study
Limits:
Female
/
Humans
Language:
Korean
Journal:
Anesthesia and Pain Medicine
Year:
2015
Type:
Article
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