Akasaka Miki, Osato Kazuhiro, Sakamoto Mito, Kihira Tomohisa, Ikeda Tomoaki, Yamawaki Takaharu
Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Ise, Japan.
Department of Obstetrics and Gynecology, Mie University Hospital, Tsu, Japan.
J Obstet Gynaecol Res. 2018 Oct;44(10):1995-1998. doi: 10.1111/jog.13717. Epub 2018 Jul 5.
Amniotic fluid embolism (AFE) causes consumption coagulopathy, which requires a massive transfusion to save the mother's life. The preparation of such a massive transfusion is too time-consuming in extremely emergent clinical settings and occasionally leads to devastating side effects such as transfusion-associated acute lung injury. C1 esterase inhibitor (C1INH) is a protein with the ability to inhibit complement, coagulation and kinin pathways. The C1INH concentration in AFE patients is low, and it has been speculated that the administration of C1INH concentrate could have a striking and beneficial effect on AFE patients in critical condition by ameliorating their perturbed coagulation system. We report the case of a 32-year-old Japanese AFE patient in whom deteriorated vital signs and coagulopathy recovered within minutes after an injection of C1INH concentrate. C1INH concentrate can quickly revive the deteriorated vital signs and the atonic uterus that stem from AFE and may reduce the total amount of transfusion.
羊水栓塞（AFE）会导致消耗性凝血病，这需要大量输血以挽救母亲的生命。在极其紧急的临床情况下，准备如此大量的输血耗时过长，且偶尔会导致诸如输血相关急性肺损伤等严重副作用。C1酯酶抑制剂（C1INH）是一种能够抑制补体、凝血和激肽途径的蛋白质。AFE患者的C1INH浓度较低，据推测，给予C1INH浓缩物可能通过改善其紊乱的凝血系统，对处于危急状态的AFE患者产生显著且有益的影响。我们报告了一例32岁的日本AFE患者，在注射C1INH浓缩物后几分钟内，其恶化的生命体征和凝血病得到了恢复。C1INH浓缩物可以迅速恢复因AFE导致的恶化生命体征和子宫弛缓，并可能减少输血量。
