Recenzija, prikaz
https://doi.org/10.20471/acc.2023.62.s2.20
Point-of-Care Diagnostic Approach in a Critically Ill Patient with Severe Bleeding from Urinary Tract
Sonja Škiljić
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Nenad Nešković
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Gordana Kristek
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Marija Milić
; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Clinical Laboratory Diagnostics, Osijek University Hospital Center, Osijek, Croatia
Hrvoje Vinković
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Karlo Kedačić
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Slavica Kvolik
; Department of Anesthesiology and Intensive care unit, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Sažetak
Coagulation disorders in critically ill patients presenting with bleeding can be multicausal.
The drugs applied can interfere and impair the coagulation cascade. Point-of-care (POC) coagulation
assays may resolve difficult therapeutic situations in critical illness. We report on a 73-year-old
critically ill male patient with massive hematuria after bladder lithotripsy. The patient was on low molecular
weight heparin therapy due to recent pulmonary embolism. He was subjected to repeated surgical
hemostasis which was ineffective despite massive transfusion protocol and normal standard coagulation
profile. Additional POC coagulation assays were obtained and were indicative of platelet dysfunction.
We revised his medical therapy and suspected the possible drug influence on platelet aggregation. After
discontinuation of target drug, platelet aggregation increased whereas hematuria stopped. Coagulation
disorders in intensive care unit patients are often multifactorial. Standard laboratory tests are unreliable
in complex refractory bleeding and may result in inappropriate therapeutic decisions. Stepwise approach
with assessment of clinical parameters, present therapy, and a combination of POC coagulation tests is
the key to optimal therapeutic management.
Ključne riječi
Amiodarone; Bleeding; Blood coagulation disorders; Drug-related side effects and adverse reactions; Platelet aggregation; Surgical hemostasis
Hrčak ID:
310129
URI
Datum izdavanja:
31.7.2023.
Posjeta: 256 *