Retroperitoneal Hematomun Neden Olduğu Nadir Bir Anemi Olgusu

Giriş: Enoksaparin tedavisi ile retroperitoneal kanama bildirilmiştir. Bu yazıda derin ven trombozuna bağlı enoksaparin kullanan bir hastada gelişen spontan retroperitoneal kanama tartışılmıştır. Vaka: Yetmiş altı yaşında erkek hasta halsizlik şikayeti ile acil servise başvurdu. Özgeçmişinde, hastamız yakın geçmişte derin ven trombozu için enoksaparin kullanmıştı. Fizik muayene, üst ekstremitede bilateral enoksaparin uygulanan bölgede subkutan minimal hematom dışında doğaldı. Laboratuvar testlerinde hemoglobin: 4.6 g/dl, üre: 158 mg/dl ve kreatinin 1.86 mg/dl olarak belirlendi. Abdominopelvik BT’de: sağ psoas kası komşuluğunda 4 cm derinliğe ulaşan retroperitoneal hemoraji tespit edildi. Takiplerinde TDP ve Eritrosit süspansiyonu replasmanı sonrası ek komplikasyon gelişmeyen, cerrahi tedavi ihtiyacı olmayan hasta, yatışının 17. gününde iyilik hali ile taburcu edildi. Sonuç: Enoksoparin tedavisi gören hastalar halsizlik şikayeti ile başvurduğunda anemi varlığında majör kanamalar görülebilir. Bu hastalarda kanama odağı açısından retroperitoneal kanama konusunda dikkatli olunmalıdır.

Anahtar Kelimeler:

anemi, retroperitoneal hematom, enoksoparin

A Rare Case of Anemia Caused by Retroperitoneal Hematoma

Introduction: Retroperitoneal hemorrhage has been reported with enoxaparin therapy. İn this article, spontaneous retroperitoneal hemorrhage developed in a patient using enoxaparin due to deep vein thrombosis is discussed. Case Report: A seventy-six-year-old male patient was admitted to the emergency department with the complaint of fatigue. On deeper introspection, our patient had, in the recent past, been used enoxaparin for deep vein thrombosis. In the physical examination was natural except subcutaneous minimal hematoma in the upper extremity bilateral enoxaparin area. İn laboratory tests, hemoglobin: 4.6 g / dl, urea: 158 mg / dl and creatinine were determined as 1.86 mg / dl. Abdominopelvic computed tomography imaging were performed and retroperitoneal hemorrhage reaching a depth of 4 cm adjacent to the right psoas muscle was detected. The patient, who did not develop additional complications after FFP and erythrocyte suspension replacement during the intensive care follow-ups and did not need surgical treatment, was discharged on the 17th day of his hospitalization in good health. Conclusion: When patients under enoxoparine treatment present with the complaint of fatigue, major bleeding may be seen when anemia is detected. One should be vigilant in terms of retroperitoneal bleeding as the bleeding focus in these patients.

Keywords:

anemia, enoxaparine, retroperitoneal hematoma,

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1. Yusuf H, Tsai J, Sıddıki A,et al. Emergency department visits by patients with venous thromboembolism, 1998-2009. J Hosp Adm 2012; 1: 1–8.
2. Othieno R, Okpo E, Forster R. Home versus in-patient treatment for deep vein thrombosis. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003076.
3. Buller HR. Treatment of symptomatic venous thromboembolism: improving outcomes. Semin Thromb Hemost 2002;28:S41–8.
4. Ernits M. Mohan P.S. Fares II, L.G. Hardy III, H. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg. 2005; 71: 430-433
5. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D (2012) Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 43:e157–e161
6. Morgan RJ, Bristol JB. Unusual findings in a patient taking warfarin. Postgrad Med J 75: 299–300, 1999
7. González, C., Penado, S., Llata, L., Valero, C. & Riancho, J. A. The clinical spectrum of retroperitoneal hematoma in anticoagulated patients. Med. 82, 257–262 (2003).
8. Chan-Tack KM. Fatal spontaneous retroperitoneal hematoma secondary to enoxaparin. South Med J 2003;96:58- 60.
9. Malik A, Capling R, Bastani B. Enoxaparin-associated retroperitoneal bleeding in two patients with renal insufficiency. Pharmacotherapy 2005;25:769-72
10. Martin E, Mohan PS, Fares LG, et al. A retroperitoneal bleed induced by enoxaparin therapy. The American surgeon. 2005;71:430-3.