A rare case of spontaneous hemoperitoneum in a bone marrow transplant recipient on VV-ECMO

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences Pub Date : 2025-02-01 DOI:10.1016/j.amjms.2024.08.017

Patrick Donabedian MD , Amir M. Emtiazjoo MD, MSc , Mindaugus Rackauskas MD, PhD , Philip Efron MD, FCCM , Cynthia Gries MD, MSc , Melissa Burger MD , Letitia Bible MD , Victoria Reams PharmD, BCTXP , Marc O. Maybauer MD, PhD , Biplab K. Saha MD

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引用次数: 0

Abstract

A 53-year-old man with acute myeloid leukemia received an allogeneic hematopoietic cell transplant (HCT) from a matched unrelated donor. One month after his transplantation, he developed ARDS requiring initiation of VV-ECMO. He suffered from pancytopenia, managed with frequent transfusions, granulocyte-colony stimulating factor (G-CSF) and weekly thrombopoietin receptor agonist. On ECMO day 17, the patient developed severe hypotension after insertion of a chest tube for a large right-sided pneumothorax. CT angiography of the abdomen showed hemoperitoneum. Exploratory laparotomy revealed approximately 4 L of blood and a ruptured splenic hilum. A splenectomy was performed. Unfortunately, the patient continued to require multiple daily blood products and his condition continued to decline despite two reoperations. His family chose to discontinue ECMO and he passed away peacefully. Spontaneous splenic rupture after GM-CSF has never been reported in patients on VV-ECMO. This manuscript reviews the literature regarding the pathophysiology and clinical manifestation of this rare occurrence.

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骨髓移植受者在使用 VV-ECMO 时发生自发性腹腔积血的罕见病例。

一名 53 岁的急性髓性白血病患者接受了匹配的非亲属供者提供的异体造血细胞移植（HCT）。移植一个月后，他出现了 ARDS，需要进行 VV-ECMO 治疗。他患有全血细胞减少症，需要频繁输血、使用粒细胞集落刺激因子（G-CSF）和每周使用血小板生成素受体激动剂。ECMO 第 17 天，患者因右侧大面积气胸插入胸管后出现严重低血压。腹部 CT 血管造影显示腹腔积血。剖腹探查术发现约 4 升血液和脾门破裂。患者接受了脾脏切除术。不幸的是，尽管进行了两次再手术，但患者每天仍需多次输血，病情持续恶化。他的家人选择停止 ECMO，他安详地离开了人世。在使用 VV-ECMO 的患者中，从未报道过 GM-CSF 后自发性脾破裂。本手稿回顾了有关这种罕见情况的病理生理学和临床表现的文献。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of the Medical Sciences 医学-医学：内科

CiteScore

4.40

自引率

0.00%

发文量

303

审稿时长

1.5 months

期刊介绍： The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include: Original clinical and basic science investigations Review articles Online Images in the Medical Sciences Special Features Include: Patient-Centered Focused Reviews History of Medicine The Science of Medical Education.