Sherer D M, Dayal A K, Schwartz B M, Oren R, Abulafia O
Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
J Matern Fetal Med. 1999 Jul-Aug;8(4):196-9. doi: 10.1002/(SICI)1520-6661(199907/08)8:4<196::AID-MFM12>3.0.CO;2-Y.
A 27-year-old patient at 13 weeks' gestation maintained on subcutaneous heparinization due to hemoglobin S and hemoglobin C (SC) sickle cell disease and previous splenic vein thrombosis presented with spontaneous acute onset of severe left lower abdominal and groin pain. The pain, which radiated to the anterior aspect of the thigh, was associated with nausea and vomiting and was exacerbated by extension of the left lower extremity. The patient was hemodynamically stable, yet during the first 24 h of hospitalization a marked decrease in hematocrit from 29% to 22% occurred. Contrast computed tomography (CT) revealed an extensive abdominal-pelvic, retroperitoneal hematoma extending approximately 15 cm in length from above L5 cephalad to below the greater trochanter of the left femur caudally. The retroperitoneal hemorrhage self-tamponaded and did not require surgical management. The dosage of heparin was decreased and maintained with appropriate activated partial prothrombin (aPTT) levels. To our knowledge, this is the first report of a spontaneous retroperitoneal hemorrhage complicating heparin anticoagulation in pregnancy. Unusual hemorrhagic complications of anticoagulation therapy are discussed.
一名27岁、孕13周的患者,因血红蛋白S和血红蛋白C(SC)镰状细胞病及既往脾静脉血栓形成,一直接受皮下肝素抗凝治疗,现出现左下腹和腹股沟区突发剧烈疼痛。疼痛放射至大腿前侧,伴有恶心和呕吐,且左下肢伸展时疼痛加剧。患者血流动力学稳定,但在住院的头24小时内,血细胞比容从29%显著降至22%。增强计算机断层扫描(CT)显示,广泛的腹盆腔、腹膜后血肿,从L5上方头侧至左股骨大转子下方尾侧,长度约15厘米。腹膜后出血自行填塞,无需手术处理。肝素剂量减少,并维持在适当的活化部分凝血活酶时间(aPTT)水平。据我们所知,这是妊娠期间肝素抗凝治疗并发自发性腹膜后出血的首例报告。本文还讨论了抗凝治疗罕见的出血并发症。