Powell Julie, Blouin Marie-Michèle, David Michèle, Dubois Josée
Division of Pediatric Dermatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
Pediatr Dermatol. 2012 Mar-Apr;29(2):182-5. doi: 10.1111/j.1525-1470.2011.01517.x. Epub 2011 Oct 13.
We present two case reports of CH in which severe bleeding episodes occurred during the first weeks of life and report the use of topical tranexamic acid to control bleeding in this setting. Patient 1 was a full-term female infant who presented at birth with a large 7- by 6-cm CH of the forehead showing a few millimeter-sized crusts. No active treatment except close follow-up was advised. At 10 weeks of age, the size of the lesion having spontaneously decreased more than 50%, she presented with severe bleeding from a small crusted area. The bleeding was controlled using topical tranexamic acid, and except for a few minor, easily controlled bleeding episodes in the following weeks, the lesion regressed more than 80%. Patient 2 was a full-term male infant seen at 1 day of life for a 14- by 10-cm CH of the right knee with a few small, dark, superficial crusts. At 3 weeks of age, he was hospitalized after severe bleeding from one of the crusted areas, with a drop in hemoglobin from 131 to 114 g/L. Bleeding was controlled using topical tranexamic acid, and compressive dressing. Because the lesion was clinically a rapidly involuting CH, there was no need for embolization or surgery. The presence of crusting in CH, even in the absence of frank ulceration, is an ominous sign and can precede serious bleeding. Tranexamic acid, an antifibrinolytic agent that helps stabilize the clot, has proved useful topically in controlling bleeding in CH.
我们报告两例先天性血管瘤（CH）病例，患儿在出生后的头几周内发生了严重出血事件，并报告了在此情况下使用局部氨甲环酸控制出血的情况。病例1是一名足月女婴，出生时前额有一个7×6厘米的巨大CH，有几个几毫米大小的结痂。除密切随访外，未建议进行积极治疗。在10周龄时，病变大小自发缩小超过50%，她出现了一个小结痂区域的严重出血。使用局部氨甲环酸控制了出血，在接下来的几周里，除了少数轻微且易于控制的出血事件外，病变消退超过80%。病例2是一名足月男婴，出生1天时因右膝有一个14×10厘米的CH，有几个小的、深色的浅表结痂而就诊。在3周龄时，他因一个结痂区域严重出血而住院，血红蛋白从131克/升降至114克/升。使用局部氨甲环酸和压迫敷料控制了出血。由于该病变临床上是一个快速消退的CH，无需进行栓塞或手术。CH中结痂的存在，即使没有明显溃疡，也是一个不祥之兆，可能先于严重出血。氨甲环酸是一种有助于稳定血凝块的抗纤维蛋白溶解剂，已证明局部使用对控制CH出血有用。
