Bhasin H K, Dana C L
Nephron. 1978;22(4-6):322-7. doi: 10.1159/000181470.
Patients maintained on chronic hemodialysis have an increased incidence of spontaneous bleeding from various parts of the body. In this paper we describe 5 patients who developed spontaneous retroperitoneal hemorrhage. All patients were receiving anticoagulants (Coumadin and/or heparin) at the time of bleeding. Clinically, retroperitoneal hemorrhage was evident in the interdialytic period. Presenting symptoms and signs included sudden and progressive onset of pain in the abdomen, flank, back, thigh or hip associated with a drop in blood pressure and hematocrit in the absence of obvious blood loss. Subsequently ecchymosis, swelling and/or mass were observed. Abdominal X-rays showed absent psoas shadows. Treatment included blood transfusions, discontinuation of Coumadin and/or heparin, the use of regional heparinization for hemodialysis and occasionally peritoneal dialysis. Surgical exploration was not required in any case and all 5 patients recovered. Anticoagulation therapy and platelet dysfunction may be contributory causes.
维持性慢性血液透析患者身体各部位自发性出血的发生率增加。在本文中，我们描述了5例发生自发性腹膜后出血的患者。所有患者在出血时均接受抗凝剂（香豆素和/或肝素）治疗。临床上，腹膜后出血在透析间期明显。出现的症状和体征包括腹部、侧腹、背部、大腿或臀部突然出现并逐渐加重的疼痛，伴有血压下降和血细胞比容降低，且无明显失血。随后观察到瘀斑、肿胀和/或肿块。腹部X线显示腰大肌阴影消失。治疗包括输血、停用香豆素和/或肝素、在血液透析中使用局部肝素化，偶尔进行腹膜透析。所有病例均无需手术探查，5例患者均康复。抗凝治疗和血小板功能障碍可能是促成因素。
