Acta Anaesthesiologica Taiwanica
Volume 48, Issue 2 , Pages 103-106, June 2010

Hypothermia as a Cause of Coagulopathy During Hepatectomy

Department of Anesthesia, Pain Service and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C

Received 23 March 2009; received in revised form 22 July 2009; accepted 27 July 2009.

Article Outline

We report a 27-year-old hemostatically competent female scheduled for partial hepatectomy. During the operation, she experienced an accidental inferior vena cava tear and suffered acute blood loss. After fluid resuscitation and blood transfusion, she developed hypothermia, with a temperature of 33.8°C, and severe coagulopathy with activated clotting time exceeding 1500 seconds measured using the Hemochron Response system (ITC, Edison, NJ, USA). Despite sufficient blood transfusion and correction of her electrolyte imbalance, the poor hemostasis persisted. After per-forming peritoneal lavage with warm saline, her condition dramatically improved and her hypothermia and severe coagulopathy were reversed.

Key Words:  blood coagulation: coagulopathy , hypothermia

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kashuk JL , Moore EE , Millikan JS , Moore JB . Major abdominal vascular trauma-a unified approach . J Trauma . 1982;22:672–679
  2. Schreiber MA . Damage control surgery . Crit Care Clin . 2004;20:101–118
  3. Bernabei AF , Levison MA , Bender JS . The effects of hypothermia and injury severity on blood loss during trauma laparotomy . J Trauma . 1992;33:835–839
  4. Schmied H , Kurz A , Sessler DI , Kozek S , Reiter A . Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty . Lancet . 1996;347:289–292
  5. Ferrara A , MacArthur JD , Wright HK , Modlin IM , McMillen MA . Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion . Am J Surg . 1990;160:515–518
  6. Cinat ME, Wallace WC, Nastanski F, West J, Sloan S, Ocariz J, et al. Improved survival following massive transfusion in patients who have undergone trauma . Arch Surg . 1999;134:964–968
  7. Johnston TD , Chen Y , Reed RL . Functional equivalence of hypothermia to specific clotting factor deficiencies . J Trauma . 1994;37:413–417
  8. Doufas AG . Consequences of inadvertent perioperative hypothermia . Best Pract Res Clin Anaesthesiol . 2003;17:535–549
  9. Rohrer MJ , Natale AM . Effect of hypothermia on the coagulation cascade . Crit Care Med . 1992;20:1402–1405
  10. Watts DD , Trask A , Soeken K , Perdue P , Dols S , Kaufmann C . Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity . J Trauma . 1998;44:846–854
  11. Miller RD . Complications of massive blood transfusions . Anesthesiology . 1973;39:82–93
  12. Miller RD , Robbins TO , Tong MJ . Coagulation defects associated with massive blood transfusions . Ann Surg . 1971;174:794–801
  13. Schreiber MA . Coagulopathy in the trauma patient . Curr Opin Crit Care . 2005;11:590–597
  14. Rossaint R, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G, et al  Key issues in advanced bleeding care in trauma . Shock . 2006;26:322–331
  15. Kozek-Langenecker SA . Effects of hydroxyethyl starch solutions on hemostasis . Anesthesiology . 2005;103:654–660
  16. Kozek-Langenecker SA , Jungheinrich C , Sauermann W , Van der Linden P . The effects of hydroxyethyl starch 130/0.4 (6%) on blood loss and use of blood products in major surgery: a pooled analysis of randomized clinical trials . Anesth Analg . 2008;107:382–390

PII: S1875-4597(10)60023-9

doi:10.1016/S1875-4597(10)60023-9

Acta Anaesthesiologica Taiwanica
Volume 48, Issue 2 , Pages 103-106, June 2010

Article Tools