title: Massive bleeding during spine surgery in a patient with ankylosing spondylitis.
abstract: OBJECTIVE
  Ankylosing spondylitis is associated with pathophysiology that has important anaesthetic implications. We report a case where the sequelae of ankylosing spondylitis may have been responsible for massive bleeding during emergency spine surgery.
  
  
  METHODS
  A 69 yr old man with long standing ankylosing spondylitis sustained a complex fracture of the lumbar spine in a fall, and was scheduled for stabilization of the spine. Under general anaesthesia, prone positioning was difficult because of the extreme spinal deformity. During exploration, dilatation of epidural veins was encountered and sustained haemorrhage was encountered throughout the surgical procedure. Estimated blood loss was 17,000 ml which was replaced with 31 units of packed red blood cells, 3200 ml of salvaged blood, 18 units of fresh frozen plasma, 26 units of platelets, 1,000 ml of albumin and 9,000 ml of crystalloid.
  
  
  CONCLUSIONS
  Extreme deformity of the spine led to positioning difficulties that may have contributed to massive blood loss during complex spine surgery. Difficulties with placement in the prone position in-patients with advanced ankylosing spondylitis should be anticipated.
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic Foundation, Ohio 44195, USA. tetzlaj@cesmtp.ccf.org
authors.forename: J E
authors.initials: JE
authors.lastname: Tetzlaff
authors.forename: H J
authors.initials: HJ
authors.lastname: Yoon
authors.forename: G
authors.initials: G
authors.lastname: Bell
mesh_terms: D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D001810:Blood Volume; D000077324:Crystalloid Solutions; D004388:Dura Mater / Q000098:blood supply; D017707:Erythrocyte Transfusion; D006801:Humans; D007552:Isotonic Solutions; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010949:Plasma; D010952:Plasma Substitutes / Q000627:therapeutic use; D017713:Platelet Transfusion; D016684:Prone Position; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion; D013167:Spondylitis, Ankylosing / Q000150:complications*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D014664:Vasodilation; D014680:Veins / Q000473:pathology
chemical_list: D000418:Albumins; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes