title: Two cases of myomectomy complicated by intravascular hemolysis and renal failure: disseminated intravascular coagulation or hemolytic uremic syndrome?
abstract: OBJECTIVE
  To present two cases of myomectomy complicated by intravascular hemolysis leading to acute renal failure and discuss the differential diagnosis and possible mechanism.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynecology.
  
  
  METHODS
  Two premenopausal patients with uterine fibroids.
  
  
  METHODS
  Both patients underwent otherwise uncomplicated myomectomies, one by laparotomy and one by laparoscopy, with tourniquets around the uterine and ovarian vessels being used to control intraoperative bleeding.
  
  
  METHODS
  Renal function in the postoperative period.
  
  
  RESULTS
  Both patients developed a very rare complication after surgery of severe thrombocytopenia with microangiopathic hemolytic anemia leading to acute renal failure. One patient made a full recovery within weeks but the other still has reduced renal function almost 2 years after the surgery. The differential diagnosis consisted of disseminated intravascular coagulation or hemolytic uremic syndrome.
  
  
  CONCLUSIONS
  The etiology of thrombotic microangiopathy in these patients was unclear, but disruption and manipulation of fibroids during surgery may have led to the dissemination of pro-coagulant tissue factor containing particles leading to disseminated intravascular coagulation or hemolytic uremic syndrome, perhaps aggravated by utero-ovarian ischemia caused by the tourniquets.
authors.affiliation: Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsimpanakos
authors.forename: John
authors.initials: J
authors.lastname: Connolly
authors.forename: Kyriaki S
authors.initials: KS
authors.lastname: Alatzoglou
authors.forename: Camilla
authors.initials: C
authors.lastname: Rowan
authors.forename: Adam
authors.initials: A
authors.lastname: Magos
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006461:Hemolysis / Q000502:physiology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis; D014594:Uterine Neoplasms / Q000601:surgery*