Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
Medicine (Baltimore). 2021 Jan 29;100(4):e24040. doi: 10.1097/MD.0000000000024040.
Hemocoagulase, a hemostatic, is used in patients with trauma, gastrointestinal bleeding, or pulmonary hemorrhage or those undergoing surgery. However, paradoxical bleeding after hemocoagulase administration is not considered a clinically significant adverse effect. Here, we report a case of paradoxical pulmonary hemorrhage associated with hypofibrinogenemia after administration of the hemocoagulase batroxobin in a patient with hemoptysis.
An 86-year-old woman complained of hemoptysis during hospitalization with organophosphate poisoning. Hemocoagulase was administered to manage bleeding; however, bleeding signs, such as hemoptysis, massive epistaxis, and ecchymosis, recurred.
The patient was diagnosed with acquired hypofibrinogenemia on the basis of the reduced plasma fibrinogen level after hemocoagulase administration and lack of other causes of bleeding.
Hemocoagulase administration was discontinued, and fibrinogen-containing plasma products were administered.
The plasma fibrinogen level normalized and bleeding signs did not recur.
It is necessary to measure plasma fibrinogen levels regularly in patients undergoing hemocoagulase administration and discontinue its administration when acquired hypofibrinogenemia is detected.
血凝酶是一种止血剂，用于创伤、胃肠道出血或肺出血患者或接受手术的患者。然而，血凝酶给药后出现的矛盾性出血并不被认为是临床上显著的不良反应。在这里，我们报告了一例与给药后低纤维蛋白原血症相关的矛盾性肺出血的病例，该患者因咯血接受了血凝酶巴曲酶的治疗。
一名 86 岁女性在因有机磷中毒住院期间出现咯血。给予血凝酶以控制出血；然而，咯血、大量鼻出血和瘀斑等出血迹象再次出现。
根据给药后血浆纤维蛋白原水平降低且无其他出血原因，诊断为获得性低纤维蛋白原血症。
停用血凝酶，并给予含有纤维蛋白原的血浆制品。
血浆纤维蛋白原水平正常，出血迹象未再发生。
在接受血凝酶治疗的患者中，有必要定期测量血浆纤维蛋白原水平，并在检测到获得性低纤维蛋白原血症时停止给药。
