Dramatic decreases of all haemorrhagic coagulation factors by acquired inhibitors after extended left lobectomy.

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Dramatic decreases of all haemorrhagic coagulation factors by acquired inhibitors after extended left lobectomy.

Int J Surg Case Rep. 2019 Jan 30;55:140-144

Authors: Sakuraoka Y, Suzuki T, Mtsumoto T, Tanaka G, Shimizu T, Shiraki T, Kyongha P, Mori S, Iso Y, Kato M, Aoki T, Kubota K

Abstract
INTRODUCTION: Acquired inhibition of coagulation factors is a rare disease, and the diagnosis is often difficult and delayed. We experienced a deficiency in all coagulation factors after hepatobiliary surgery.
CASE PRESENTATION: Extended left liver resection was undertaken and hepaticojejunostomy was performed in a 70-year-old man. He had suffered from a high fever caused by cholangitis for 35 days. The major cause was a narrowing of the hepaticojejunostomy, and reconstruction was carried out. Twenty-four days later, there was a sudden massive bleed from his nose and the surgical site. Steroid pulse therapy was used as a treatment because cross mixing and some blood tests revealed the patient was experiencing an inhibition of all coagulation factors, and consequently the levels of coagulation factors dramatically recovered.
DISCUSSION: We considered malignancy and surgical damages to be the underlying cause. The reported treatment and examination will help clinicians explore additional reasons for massive bleeding after a severe physical injury.
CONCLUSION: We have described the first case of acquired inhibition of all coagulation factors associated with extended left lobectomy.

PMID: 30731301 [PubMed - as supplied by publisher]

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