Successful perioperative management of a patient with erythropoietin-producing uterine myoma
Successful perioperative management of a patient with erythropoietin-producing uterine myoma
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DOI：
10.1186/s40981-018-0185-y
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发表时间：
2018-06-18
影响因子：
0.9
通讯作者：
Nishikawa, Koichi
中科院分区：
文献类型：
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作者：
Kobayashi, Masato;Akatsu, Masahiko;Nishikawa, Koichi
背景：产生促红细胞生成素的子宫肌瘤可引起各种并发症，如动脉或静脉血栓形成和出血。因此，患者的麻醉处理需要谨慎。病例表现：一位57岁的女性被怀疑患有促红细胞生成素的子宫肌瘤，计划接受腹部全子宫切除术和双侧输卵管卵巢切除术。术前血红蛋白21.9g/dl(正常值11.5~15g/dl)，红细胞生成素23.2IU/ml(正常值4.2~23.7IU/ml)。在先前的证据表明，16g/dl的血红蛋白水平可以减少真性红细胞增多症相关并发症的发生后，手术前进行了静脉切开和等容血液稀释，以预防动脉和静脉血栓形成。术后每日皮下注射磺达肝素2.5 mg，围手术期无严重并发症发生。结论：本研究成功地治疗了1例促红细胞生成素分泌子宫肌瘤患者。我们在这个病例中的发现表明，这种抗血栓治疗的组合可以促进这种疾病患者的麻醉管理。
Background: Erythropoietin-producing uterine myoma can cause various complications such as arterial or venous thrombosis and bleeding. Therefore, caution is required in the anesthetic management of affected patients.Case presentation: A 57-year-old female was suspected to have an erythropoietin-producing uterine myoma and was scheduled to undergo an abdominal total hysterectomy and bilateral salpingo-oophorectomy. Preoperative levels of hemoglobin and erythropoietin were 21.9 g/dl (normal 11.5-15 g/dl) and 23.2 IU/ml (normal 4.2-23.7 IU/ml), respectively. Preoperative phlebotomy and isovolemic hemodilution were performed to prevent arterial and venous thrombosis, following previous evidence that a hemoglobin level < 16 g/dl reduces the occurrence of polycythemia vera-related complications. Fondaparinux 2.5 mg was subcutaneously injected once daily after the operation, resulting in a good perioperative course without major complications.Conclusion: Herein, we have described a successful perioperative management of a patient with erythropoietin-producing uterine myoma. Our findings in this case suggest that this combination of antithrombotic therapies can facilitate anesthetic management of patients with this disease.