Mine ÇELİK, Gökçe CİNLİ, Necmiye AY, İlteriş YAMAN, Neslihan KURMAZ

LAPAROSKOPİK HİSTEREKTOMİ UYGULANAN FAKTÖR 7 YETERSİZLİĞİ OLAN HASTADA NADİR BİR KOMPLİKASYON; POSTOPERATİVE PULMONER EMBOLİ

Faktör VII (FVII) yetmezliği kongenital otozomal resesif geçen pıhtılaşma bozukluğu olup prevelansı 1:500.000 dir. Bu olgu sunumunda anormal uterus kanaması olan faktör VII eksikliği mevcut ve laparokopik histerektomi planlanan 41 yaşındaki hastanın anestezi yönetimi ve yoğun bakım sürecini sunmayı amaçladık. 41 yaşında (60 kg, 164 cm) önceden bilinen Faktör VII (FVII) yetmezliği olan hasta anormal uterin kanama öyküsü ile operasyon planlandı. Preoperatif laboratuvar PT:70, INR:6.9 ,PTT:29 Hb: 13.3, Plt:274 ve F VII: %1.1 idi. Anestezi indüksiyonunu takiben operasyon başlamadan 10 dakika önce 1500 mcg rFVIIa intravenöz yoldan 3 dakikada yavaş infüzyon ile verildi. Intraoperatif ilk koagülasyon parametreleri PT: 20.14, INR:0.8,aPTT: 27.3 olarak görüldü. Cerrahi esnasında minimal kanama oldu Hastanın operasyonu bitiminde extübe edildikten 5 dakika sonra Elektrokardiyografide ST elevasyonu, taşikardi (128/dk) hipotansiyon (60/30 mmHg) ve oksijen satürasyonunda ani düşme (SpO2 ) gözlendi. Pulmoner BT anjiyo incelemesinde: Sağ ana pulmoner arter alt loblarında ve sol ana pulmoner arter alt lob dallarında yer yer akıma izin veren hipodens trombüs materyali ile uyumlu görünüm mevcuttu. Postoperatif 3 gün yoğun bakımda akip edilen hasta servise çıkarıldı. Faktör VII yetmezliği olan hastalarda hematoloji klavuzlarında da önerilen dozlarda da tromboemboli komplikasyonlarının olabileceği akılda tutulmalıdır.

Anahtar Kelimeler:

Faktör VII yetmezliği, pulmoner emboli, laparoskopi, histerektomi

A RARE COMPLICATION IN A PATIENT WITH FACTOR VII DEFICIENCY UNDERWENT LAPAROSCOPIC SURGERY: POSTOPERATIVE PULMONARY EMBOLISM

Factor VII (FVII) deficiency is a congenital autosomal recessive coagulation disorder with a prevalence of 1:500,000. In this case report, we aimed to present the anesthesia management and intensive care process of a 41-year-old patient with abnormal uterine bleeding, factor VII deficiency and planned laparoscopic hysterectomy. An operation was planned for a 41-year-old (60 kg, 164 cm) patient with known Factor VII (FVII) deficiency with a history of abnormal uterine bleeding. Preoperative Laboratory values were as follows; PT: 70, INR: 6.9, aPTT: 29 Hb: 13.3, Plt: 274 and F VII: 1.1%. Following the induction of anesthesia, 1500 mcg rFVIIa (novoseven NOVO NORDİSK HEALTH PRODUCTS) was given intravenously over 3 minutes by slow infusion 10 minutes before starting the operation. Intraoperative first coagulation parameters were PT: 20.14, INR: 0.8, aPTT: 27.3. There was minimal bleeding during the surgery. At the end of the operation, 5 minutes after the patient was extubated, ST elevation, tachycardia (128/min), hypotension (60/30 mmHg) and a sudden decrease in oxygen saturation (SpO2) were observed in the electrocardiogram. In pulmonary CT angiography, there was an appearance consistent with hypodense thrombus material that allowed flow in placed plin the lower lobes of the right main pulmonary artery and in the lower lobe branches of the left main pulmonary artery. The patient, who was followed up in the intensive care unit for 3 days postoperatively, was taken to the ward. It should be kept in mind that thromboembolism complications may occur in patients with factor VII deficiency, even given doses recommended in hematology guidelines.

Keywords:

Factor VII failure, pulmonary embolism, laparoscopy, histerectomy,

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