Cargando…
Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors
Patient: Male, 71 Final Diagnosis: Hemophilia A Symptoms: Dysarthria • dysphagia • dyspnea Medication: — Clinical Procedure: Cricothyrotomy • tracheotomy Specialty: Hematology OBJECTIVE: Unusual clinical course BACKGROUND: Massive tongue hemorrhage in patients with hemophilia is a medical emergency...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647615/ https://www.ncbi.nlm.nih.gov/pubmed/31303639 http://dx.doi.org/10.12659/AJCR.916151 |
_version_ | 1783437749587542016 |
---|---|
author | Kageyama, Yuki Matsumoto, Takeshi Tawara, Isao Wada, Hideo Katayama, Naoyuki |
author_facet | Kageyama, Yuki Matsumoto, Takeshi Tawara, Isao Wada, Hideo Katayama, Naoyuki |
author_sort | Kageyama, Yuki |
collection | PubMed |
description | Patient: Male, 71 Final Diagnosis: Hemophilia A Symptoms: Dysarthria • dysphagia • dyspnea Medication: — Clinical Procedure: Cricothyrotomy • tracheotomy Specialty: Hematology OBJECTIVE: Unusual clinical course BACKGROUND: Massive tongue hemorrhage in patients with hemophilia is a medical emergency because it can lead to airway obstruction. However, managing bleeding in patients with inhibitors is more difficult than in patients without inhibitors. We report a case of life-threatening massive tongue and retropharyngeal hematoma in a patient with hemophilia A who had inhibitors. CASE REPORT: The patient was a 71-year-old man with severe hemophilia A with high-responding inhibitors. He was admitted to our hospital with dysarthria and dysphagia secondary to a massive tongue hematoma. Although bypassing therapy was started immediately after admission, he rapidly developed an airway obstruction and cardiopulmonary arrest secondary to suffocation. Cardiopulmonary resuscitation and surgical cricothyrotomy were performed, which restored his pulse and breathing. On day 5 of hospitalization, he underwent tracheotomy under inhibitor-neutralizing therapy, and we began emicizumab on day 19 of hospitalization to prevent further bleeding events. He recovered and was transferred to another hospital for rehabilitation on day 64 of hospitalization. CONCLUSIONS: Because tongue hematomas progress dramatically within a few days, prompt airway maintenance by tracheotomy under appropriate hemostatic therapy must be considered. Furthermore, emicizumab induction after primary hemostasis prevents further bleeding. We suggest that initiating emicizumab therapy is a good choice to prevent further bleeding after critical bleeding events if the patient has not received the drug previously. |
format | Online Article Text |
id | pubmed-6647615 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-66476152019-08-09 Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors Kageyama, Yuki Matsumoto, Takeshi Tawara, Isao Wada, Hideo Katayama, Naoyuki Am J Case Rep Articles Patient: Male, 71 Final Diagnosis: Hemophilia A Symptoms: Dysarthria • dysphagia • dyspnea Medication: — Clinical Procedure: Cricothyrotomy • tracheotomy Specialty: Hematology OBJECTIVE: Unusual clinical course BACKGROUND: Massive tongue hemorrhage in patients with hemophilia is a medical emergency because it can lead to airway obstruction. However, managing bleeding in patients with inhibitors is more difficult than in patients without inhibitors. We report a case of life-threatening massive tongue and retropharyngeal hematoma in a patient with hemophilia A who had inhibitors. CASE REPORT: The patient was a 71-year-old man with severe hemophilia A with high-responding inhibitors. He was admitted to our hospital with dysarthria and dysphagia secondary to a massive tongue hematoma. Although bypassing therapy was started immediately after admission, he rapidly developed an airway obstruction and cardiopulmonary arrest secondary to suffocation. Cardiopulmonary resuscitation and surgical cricothyrotomy were performed, which restored his pulse and breathing. On day 5 of hospitalization, he underwent tracheotomy under inhibitor-neutralizing therapy, and we began emicizumab on day 19 of hospitalization to prevent further bleeding events. He recovered and was transferred to another hospital for rehabilitation on day 64 of hospitalization. CONCLUSIONS: Because tongue hematomas progress dramatically within a few days, prompt airway maintenance by tracheotomy under appropriate hemostatic therapy must be considered. Furthermore, emicizumab induction after primary hemostasis prevents further bleeding. We suggest that initiating emicizumab therapy is a good choice to prevent further bleeding after critical bleeding events if the patient has not received the drug previously. International Scientific Literature, Inc. 2019-07-15 /pmc/articles/PMC6647615/ /pubmed/31303639 http://dx.doi.org/10.12659/AJCR.916151 Text en © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Kageyama, Yuki Matsumoto, Takeshi Tawara, Isao Wada, Hideo Katayama, Naoyuki Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title | Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title_full | Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title_fullStr | Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title_full_unstemmed | Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title_short | Life-Threatening Tongue and Retropharyngeal Hemorrhage in a Patient with Hemophilia A with Inhibitors |
title_sort | life-threatening tongue and retropharyngeal hemorrhage in a patient with hemophilia a with inhibitors |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647615/ https://www.ncbi.nlm.nih.gov/pubmed/31303639 http://dx.doi.org/10.12659/AJCR.916151 |
work_keys_str_mv | AT kageyamayuki lifethreateningtongueandretropharyngealhemorrhageinapatientwithhemophiliaawithinhibitors AT matsumototakeshi lifethreateningtongueandretropharyngealhemorrhageinapatientwithhemophiliaawithinhibitors AT tawaraisao lifethreateningtongueandretropharyngealhemorrhageinapatientwithhemophiliaawithinhibitors AT wadahideo lifethreateningtongueandretropharyngealhemorrhageinapatientwithhemophiliaawithinhibitors AT katayamanaoyuki lifethreateningtongueandretropharyngealhemorrhageinapatientwithhemophiliaawithinhibitors |