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Canadian Journal of Anesthesia, Vol 37, 910-912, Copyright © 1990 by Canadian Anesthesiologists' Society

ARTICLES

Amyloidosis associated bleeding diatheses in the surgical patient

AR Mizutani and CF Ward
Department of Anesthesiology, University of California, San Diego 92103.

The coagulopathies associated with amyloidosis have not been widely appreciated. We encountered a patient with amyloidosis and mildly abnormal coagulation studies who presented for an emergency laparotomy for acute bowel obstruction. Upon gentle manipulation of the bowel, an unexpected bleeding diathesis was manifested by the formation of several large haematomas resulting in a large amount of blood loss (approximately 800 ml). Numerous defects of platelet function and coagulation have been associated with amyloidosis, including abnormal platelet aggregation, increased vascular fragility, factor IX and X deficiencies, decreased levels of alpha-2-plasmin inhibitor, and increased levels of plasminogen. Intraoperative therapy for our patient included the rapid administration of four units of fresh frozen plasma and ten units of platelet concentrate. A review of the pathology and therapeutic modalities for this potentially life-threatening complication is presented.




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Copyright © 1990 by the Canadian Anesthesiologists' Society.