Recombinant factor VIIa in management of spontaneous subcapsular liver hematoma associated with pregnancy.
BACKGROUND
Spontaneous subcapsular liver hemorrhage is a rare but life-threatening complication of pregnancy. Optimal management of an expanding hematoma or ruptured capsule has not been established.


METHODS
We report 3 patients with preeclampsia and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome with spontaneous subcapsular liver hematomas. The first 2 patients with ruptured liver hematomas experienced life-threatening hemorrhage. The third patient experienced uncontrollable vaginal bleeding, liver hemorrhage, and was in imminent danger of capsule rupture. Despite aggressive surgical intervention and traditional blood component therapy, adequate hemostasis could not be achieved in any of these patients. Recombinant factor VIIa was used to achieve hemostasis in all three patients.


CONCLUSIONS
Recombinant factor VIIa is an effective adjunct in the treatment of preeclamptic patients with expanding or ruptured subcapsular liver hematoma.
Merchant
Shakil H
SH
Department of Pathology, University of New Mexico, Albuquerque, New Mexico 87131, USA.
Mathew
Prasad
P
Vanderjagt
Timothy J
TJ
Howdieshell
Thomas R
TR
Crookston
Kendall P
KP
D000328:Adult; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy*; D006406:Hematoma / Q000188:drug therapy; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy; D011225:Pre-Eclampsia / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012422:Rupture, Spontaneous
D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa