Liu Shangxiang, Mei Chengqing, Zou Hui, Chang Xiaoliang, Ye Zhenglong
Intensive Care Unit, Nanjing Jiangbei People's Hospital Affiliated to Nantong University, Nanjing, P.R. China.
SAGE Open Med Case Rep. 2020 Jun 13;8:2050313X20931680. doi: 10.1177/2050313X20931680. eCollection 2020.
Iliopsoas hematoma is an uncommon clinical entity that may develop in association with anticoagulation states, coagulopathies and hemodialysis, or anticoagulant therapy. Here, we report a case of unilateral iliopsoas hematoma in a 60-year-old man who received low-molecular-weight heparin for anticoagulation due to continuous veno-venous hemofiltration. The patient presented with fever and productive cough for 2 days. He received continuous veno-venous hemofiltration due to rising blood urea nitrogen (22.7 mmol/L; normal references: 3.2-7.1 mmol) and creatinine (1345 µmol/L; normal references: 53-106 µmol/L). Low-molecular-weight heparin (enoxaparin, 3500-5500 Da, 5-10 IU/kg/h) was delivered continuously by pumps for anticoagulation therapy. At day 12 post heparin treatment, the patient complained left back pain. Platelet count (243 × 10/L) was normal, but both activated partial thromboplastin time (67.5 s) and prothrombin time (17.3 s) were prolonged. Abdominal computed tomography scan revealed left iliopsoas swelling with an indistinct border. Low-molecular-weight heparin was discontinued. Anti-Xa was not monitored throughout the treatment. No improvement was seen, and 3 days later, the patient died after his family decided to terminate therapy. This case highlights the needs for careful anticoagulation as well as close monitoring, and particularly the use of anti-Xa to guide the treatment.
髂腰肌血肿是一种罕见的临床病症，可能与抗凝状态、凝血障碍、血液透析或抗凝治疗有关。在此，我们报告一例60岁男性单侧髂腰肌血肿病例，该患者因持续静静脉血液滤过接受低分子量肝素抗凝治疗。患者出现发热和咳痰2天。由于血尿素氮（22.7 mmol/L；正常参考值：3.2 - 7.1 mmol）和肌酐（1345 μmol/L；正常参考值：53 - 106 μmol/L）升高，他接受了持续静静脉血液滤过。通过泵持续给予低分子量肝素（依诺肝素，3500 - 5500 Da，5 - 10 IU/kg/h）进行抗凝治疗。肝素治疗后第12天，患者诉左侧背痛。血小板计数（243×10/L）正常，但活化部分凝血活酶时间（67.5 s）和凝血酶原时间（17.3 s）均延长。腹部计算机断层扫描显示左侧髂腰肌肿胀，边界不清。停用低分子量肝素。整个治疗过程中未监测抗Xa水平。未见病情改善，3天后，在患者家属决定终止治疗后患者死亡。该病例强调了谨慎抗凝以及密切监测的必要性，特别是使用抗Xa来指导治疗。
