Service de Nephrologie Dialyse Apherese, Service Nephrology Dialysis Apheresis, Nîmes University Hospital Carémeau, Nîmes, France.
Gynecology Obstetrics and Reproductive Medicine Department, University Hospital Caremeau, Nîmes, France.
J Nephrol. 2022 Dec;35(9):2433-2435. doi: 10.1007/s40620-022-01270-8. Epub 2022 Mar 3.
We report the case of a 31-year-old patient on chronic hemodialysis for 17 years, after two failed kidney grafts, presently on daily home hemodialysis. She underwent follicle puncture for oocyte retrieval in the context of an in vitro fertilization program. This procedure was complicated by hemoperitoneum, requiring transfusion of 2 units of packed red blood cells and 2 units of fresh-frozen plasma, as well as an emergency laparoscopy to drain the hemoperitoneum and perform local hemostasis of the ovarian bleeding. This complication occurred following the patient's routine hemodialysis session, performed with the usual systemic anticoagulation with unfractionated heparin. The evolution was favorable and there was no recurrence of bleeding or sequelae. A later hematology workup did not reveal any pathology of hemostasis that might have favored bleeding. This case may underline how, even though assisted reproductive procedures are increasingly performed in patients on dialysis, special care should be taken when these procedures are performed in this fragile population.
我们报告了一例 31 岁的患者，该患者患有慢性血液透析 17 年，曾进行过两次肾脏移植失败，目前正在进行每日家庭血液透析。她在体外受精计划中进行了卵泡穿刺以获取卵母细胞。该过程并发了血性腹腔内，需要输注 2 单位浓缩红细胞和 2 单位新鲜冷冻血浆，并进行紧急腹腔镜检查以排空血性腹腔并对卵巢出血进行局部止血。该并发症发生在患者常规血液透析治疗后，使用普通肝素进行了常规全身抗凝治疗。病情进展良好，无再次出血或后遗症。随后的血液学检查并未发现任何可能导致出血的止血功能障碍。该病例可能表明，即使越来越多的透析患者接受辅助生殖程序，但在对这一脆弱人群进行这些程序时，应特别注意。
