Post splenectomy fatal pulmonary embolism in a patient with moderate hemophilia A

Davoodabadi, A. and Adib-Hajbaghery, M. and Keleidari, B. (2011) Post splenectomy fatal pulmonary embolism in a patient with moderate hemophilia A. Iranian Journal of Medical Sciences, 36 (2). pp. 136-140.

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Hemophilia A is a bleeding disorder caused by defective production of factor VIII. The main concern associated with the disease is bleeding, especially after trauma and surgeries. Facto VIII replacement therapy is associated with substantial decrease of bleeding events during surgery. However, there have been a number of reports of thromboemblic events in this situation. The present report describes a case of moderate hemophilia A in which splenectomy did lead to pulmonary embolism and subsequent death. The patient was a 25-year-old man with hemophilia A admitted after a car accident and trauma to left lower chest and abdomen. He received factor VIII concentrates for replacement therapy. He was hemodynamically stable on the first day, but on the second day his hemoglobin declined and he showed signs of abdominal tenderness. He, therefore, was subjected to laparatomy and splenectomy. After the operation, he suddenly developed dyspnea and decline in blood pressure, and death afterwards. Autopsy of the patient revealed massive pulmonary thromboembolism. The symptoms and outcome of the present case indicate that although pulmonary thromboembolism in the early postoperative period in patients with hemophilia A undergoing splenectomy and receiving factor VIII concentrate for replacement is rare, it should not be assumed a far-fetched event, and prophylactic measures to prevent thromboemboly must be considered.

Item Type: Article
Additional Information: cited By 2
Uncontrolled Keywords: blood clotting factor 8 concentrate; hemoglobin, abdominal injury; abdominal tenderness; adult; article; autopsy; bolus injection; case report; death; dyspnea; echography; fatality; hemodynamics; hemoglobin blood level; hemophilia A; hemoptysis; human; hypotension; injury severity; international normalized ratio; laparotomy; lung embolism; male; partial thromboplastin time; peritoneal cavity; spleen injury; splenectomy; thorax injury; thrombocyte count; traffic accident
Subjects: Medicine
Divisions: Faculty of Medicine > Clinical Sciences > Department of Surgery
Depositing User: editor . 2
Date Deposited: 27 Feb 2017 08:00
Last Modified: 22 May 2017 14:11

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