title: Acute hypotension associated with intraoperative cell salvage using a leukocyte depletion filter during management of obstetric hemorrhage due to amniotic fluid embolism.
abstract: Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication that can lead to profound coagulopathy and hemorrhage. The role of cell salvage and recombinant human Factor VIIa (rFVIIa) administration in such cases remains unclear. We present a case of AFE and describe our experience with the use of cell salvage and rFVIIa administration during the resuscitation. Cell salvage and transfusion through a leukocyte depletion filter was attempted after the diagnosis of AFE was made, but the attempted transfusion was immediately followed by hypotension and a worsening of hemodynamics. rFVIIa, on the contrary, was used with clinical improvement in coagulopathy and without apparent adverse thrombotic effect.
authors.affiliation: Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., B6/319 CSC, Madison, WI 53792-3272, USA. wrogers@uwhealth.org
authors.forename: William Kirke
authors.initials: WK
authors.lastname: Rogers
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Wernimont
authors.forename: Girish C
authors.initials: GC
authors.lastname: Kumar
authors.forename: Eliza
authors.initials: E
authors.lastname: Bennett
authors.forename: David H
authors.initials: DH
authors.lastname: Chestnut
mesh_terms: D000208:Acute Disease; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001804:Blood Transfusion, Autologous / Q000009:adverse effects* / Q000295:instrumentation; D002585:Cesarean Section / Q000009:adverse effects*; D003029:Coagulants / Q000627:therapeutic use; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation; D057725:Operative Blood Salvage / Q000009:adverse effects* / Q000295:instrumentation; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D003029:Coagulants; D011994:Recombinant Proteins; D014662:Vasoconstrictor Agents; C103587:recombinant FVIIa; D015942:Factor VIIa