Protamine sulphate for treatment of severe post-reperfusion coagulopathy in pediatric liver transplantation.
In this case report, we describe a child with biliary atresia who underwent a living LDLT and developed severe coagulopathy after reperfusion of the graft. The ROTEM analysis strongly suggested the presence of either a heparin effect or severe deficiency of coagulation factors. The former diagnosis was supported by a subsequent in-vitro HEPTEM. A small dose of protamine sulphate was then administered, which promptly restored hemostasis. The remainder of the procedure was uneventful.
Gouvêa
Glauber
G
Liver Transplant Unit, Department of Anesthesiology, Bonsucesso General Hospital (HGB), Rio de Janeiro, Brazil. glaubergouvea@ibest.com.br
Toledo
Renato
R
Diaz
Rodrigo
R
Auler
Lúcio
L
Enne
Marcelo
M
Martinho
José Manoel
JM
D001656:Biliary Atresia / Q000601:surgery*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011479:Protamines / Q000627:therapeutic use*; D012086:Reoperation; D015424:Reperfusion / Q000009:adverse effects
D006494:Heparin Antagonists; D011479:Protamines