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///2016 Abstract Details
2016 Abstract Details2019-07-15T10:10:51-05:00

A case of obstetric disseminated intravascular coagulation (DIC) that was successfully treated using Dry-hematology system (DRIHEMATO®)

Abstract Number: SU-86
Abstract Type: Case Report/Case Series

Asako Kumagai M.D.1 ; Hiroyuki Sumikura M.D.Ph.D2; Nanako Mizuta M.D.3; Hiroko Tsujihara M.D.4; Hisako Okada M.D..5; Yosuke Mori M.D.6

A case of obstetric disseminated intravascular coagulation (DIC) that was successfully treated using Dry-hematology system (DRIHEMATO®)

Background:

The importance of fibrinogen replacement in the treatment of obstetric disseminated intravascular coagulation (DIC) has been well recognized. However, it takes more than thirty minutes to measure the serum fibrinogen concentration with a conventional measurement device in a laboratory. Hence, it used to be difficult to reflect the measured fibrinogen concentration in the treatment of obstetric DIC, which progresses very quickly, and in the assessment of the efficacy of the treatment. Recently, a point of care measurement device of fibrinogen (DRIHEMATO®) has been developed and offered commercially in Japan. We present a case of successful treatment of obstetric DIC with DRIHEMATO®.

Case:

Thirty-six years old, nulliparous woman, who underwent Caesarian section due to arrested labor, was transferred to our hospital because of uncontrollable postpartum hemorrhage. The total blood loss until arrival was reported to be 4120ml, and the fluid resuscitation had been performed with 2500ml of crystalloid, 2500ml of colloid, 8U of RBC (1120ml) and 4U of FFP (480ml). Because of this massive infusion, her shock index at arrival was 0.85 (blood pressure 115/65 mmHg, heart rate 98 bpm). Immediately after her arrival, fibrinogen concentration was found to be 23mg/dl by DRIHEMATO®, and diluted coagulopathy was suspected. Hence 3g of the concentrated fibrinogen preparation was administered. After the administration, fibrinogen concentration was found to be 46mg/dl by DRIHEMATO®, and consumption coagulopathy was suspected. Hence, 10U of cryoprecipitate was administered. These aggressive fibrinogen replacements resulted in the withdrawal from the emergency state of the obstetric DIC, and elevated fibrinogen concentration (110mg/dl) was confirmed by ordinal laboratory measurement.

Discussion:

DRIHEMATO® has been invented in Japan and been on the market for two years. Although the efficacy of DRIHEMATO® has already been established in the stable state, the reliability of the device has never been studied in the unstable state such as obstetric DIC. In our case, DRIHEMATO® was effectively used as a tool for the decision making in the unstable state of obstetric DIC. However, further study is needed to confirm its reliability in unstable status.



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