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A case of hemophilia complicated by massive hemorrhage of hemangioma was successfully treated by the hematology institute in our hospital
Author:xaszxyy  Release date:2018-09-03


    Recently, a 59-year-old male patient suffered from continuous bleeding after hip hemangioma resection in other hospital. He suspected that he got hematologic disease, therefore, he came to the hematology institute of our hospital. The patient was diagnosed as hemophilia A after examination. Later, due to the rupture of the remaining hemangioma, a fatal hemorrhage occurred. After 8 consultations and joint rescue in 9 disciplines of our hospital, the patient recovered and was discharged from the hospital.
    

    In early february, the patient, surnamed dong, was admitted to hospital due to a huge lump in the left buttock. The left gluteal mass was removed in parallel, and the postoperative pathology suggested hemangioma. However, the surgical wound continued to bleed and could not be healed, and a hematoma was formed. Then he was sent to our hospital. The results of blood clotting examination indicated that APTT was prolonged, and the further investigation showed that the activity of coagulation factor VIII was 35%, less than half that of normal, which was clearly diagnosed as hemophilia A. We conducted blood clotting factor VIII treatment, at the same time symptomatic treatment , such as anti-infection, stop bleeding. Yue Han, the chief physician of burn orthopaedic department, was consulted and the wound bleeding was reduced after 2 weeks of intermittent drug exchange. However, it was still difficult to heal. Jian Tao, chief physician of burn orthopaedic department, conducted the left hip wound hematoma removal, and then the situation was stable. However, at 00:03 on March 08, after the patient turned over, the hip wound was bleeding, and he was pale, short of breath. His blood pressure dropped to 52/29mmHg, hemorrhagic shock occurred, and the condition was critical. We immediately gave rehydration, maintained blood pressure, contact with the Department of Blood Transfusion, emergency blood transfusion and other rescue measures, and once again invited the Chief Physician Jian Tao at 2:20 am to conduct emergency surgery. As the bleeding site was close to the pelvic cavity, Chief Physician Tao Wang was invited to assist. During operation, it could be seen that there was a thick tissue of about 7-9mm in the deep part of the wound. It was suspected that the arterial vascular tissue was caused by residual hemangiomas. After multiple sutures, the bleeding stoped and the patient returned to the ward. According to Jian Tao, the tissue surrounding the hemangioma was crunchy, the suture effect was not accurate, and it was easy to bleed again. Once bleeding, the arterial blood vessels might be retracted into the pelvic cavity, and the possibility of survival was minimal. It was recommended to perform further vascular embolization in the interventional department. Wei Chen, deputy chief physician of general three department, also recommended local vascular embolization. Urgently, director Yiqing Wang of the interventional department believed that direct interventional therapy was of high risk. It was recommended to improve the vascular CTA examination before deciding whether or not to perform vascular embolization. Considering that the patient had active bleeding, the risk of CTA examination was extremely high, after reporting to Director Yanping Song, we immediately explained the situation to the chief of medical department, Chao Liu, and the deputy chief, Wei du. The Medical Department attached great importance to it and coordinated various departments to make full preparations and smooth access to rescue channels. Director of the Department of Burns, Zhanfeng Ru, and Chief Physician Jian Tao said that if an accident occured during the CTA process, they would try their best to rescue. Director Yanping Zhang of the Second Department of Pediatrics and Director Limin Tian of the General Three Department also agreed. Director Xiaoping Wu also made preparation to rescue the patient. Under the careful and meticulous arrangement of the imaging department, the CTA inspection was successfully completed. After observing, Director Yiqing Wang considered that there was an indication for interventional therapy. At 4:30 pm on the same day, the DSA+ vascular embolization of the left internal iliac artery was successfully completed. Later, the wound gradually recovered. The burn department continued to change the medicine for the patient. The patient did not blood again and the condition continued to be stable. He was discharged from hospital on 22 March. The patient shed tears of excitement. He said: " Xi'an Central Hospital gave me a second life, thank you!".
  

    This multidisciplinary joint rescue fully demonstrated the ability of our hospital to treat patients with critical and complicated conditions. Meanwhile, it further enhanced the mutual trust between medical personnel, and cooperated with each other in the department, reflecting the professional level of grade III, class A hospital.