[Worsening of chronic disseminated intravascular coagulation after embolization of the renal artery].
A case is reported of a 60 year-old patient with chronic disseminated intravascular coagulation (DIC) which was increased by the therapeutic embolization of a renal tumour. The patient had 2 primary carcinomas (renal and prostatic) with vertebral metastases, severe chronic anaemia (due to haematuria), and chronic DIC, with thrombocytopaenia, soluble complexes, and fibrinogen and fibrin degradation products. Therapeutic embolization of the renal artery was carried out with fragments of dura mater. Although the result was anatomically very satisfactory, the patient's condition worsened, with continuing haematuria, and development of an haematoma in the lumbar fossa. Coagulation factors and antithrombin III (AT III) concentrations decreased, whereas the activated partial thromboplastin, thrombin and reptilase times increased. The patient also suffered from acute renal failure (creatinine: 690 mumol.l-1). Treatment consisted in fluid replacement, red blood cell and platelet transfusions, 150 IU.kg-1.d-1 heparin and 20 IU.kg-1.d-1 AT III. Haematological tests returned to pre-embolization values on the ninth day. The sudden worsening in the patient's condition was probably due to the sudden massive release of tissue thromboplastins related to the renal necrosis induced by the therapeutic embolization. The use of heparin AT III in the management of this patient is discussed.
Galet
A
A
Département d'Anesthésie-Réanimation Chirurgicale 2, Hôpital Régional, Centre Hospitalier Universitaire, Lille.
Smith-Morel
P
P
Goudemand
J
J
D000990:Antithrombin III / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001792:Blood Platelets; D001803:Blood Transfusion; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006417:Hematuria / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D013925:Thromboplastin / Q000378:metabolism
D001779:Blood Coagulation Factors; D000990:Antithrombin III; D006493:Heparin; D013925:Thromboplastin
Aggravation d'une coagulation intravasculaire disséminée chronique après embolisation d'une artère rénale.