Anesth Pain Med.  2015 Oct;10(4):295-300. 10.17085/apm.2015.10.4.295.

Sudden cardiovascular collapse after platelet transfusion during liver transplantation: flat-line thromboelastometry and inferred pulmonary thromboembolism: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kshwang@ amc.seoul.kr

Abstract

Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.

Keyword

Liver transplantation; PTE; ROTEM

MeSH Terms

Blood Component Removal
Blood Platelets*
Blood Pressure
Carcinoma, Hepatocellular
Cardiopulmonary Resuscitation
Disease Susceptibility
Echocardiography, Transesophageal
Female
Heart Atria
Hemorrhage
Humans
Liver Diseases
Liver Transplantation*
Liver*
Middle Aged
Mortality
Platelet Transfusion*
Pulmonary Embolism*
Shock
Thrombelastography*
Thrombocytopenia
Full Text Links
  • APM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr