Altered Clotting Essays

Altered Clotting Essays-24
As power came to 4/5 in both LL in 4 h, we had decided to wait till morning.

As power came to 4/5 in both LL in 4 h, we had decided to wait till morning.

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In the absence of neurosurgeon and functional magnetic resonance imaging (MRI), we decided to shift the patient to a higher center for further management.

Meanwhile, we started injection methylprednisolone 1.8 g infusion over 30 min followed by 324 mg/h, injection tranexamic acid 600 mg over 5 min and injection Vitamin K 10 mg. Surprisingly, patient's power improved between 1/5 to 2/5 in the left LL and 2/5 to 3/5 in the right LL in 2 h of starting steroids.

As MRI was unavailable hematoma could not be confirmed.

The basic treatment for spinal hematoma is surgical decompression.

A male patient aged 45 years was admitted to the Department of General Surgery with a complaint of acute abdomen, diagnosed as acute appendicitis and posted for an open appendectomy.

During preoperative examination thalassemia trait was elicited, he was evaluated previously in an institute after his son was diagnosed as thalassemia major.

Preoperative vitals were BP - 130/84, pulse rate - 78/min, Sp O-98%.

The patient was preloaded with Ringer lactate (15 ml/kg) after securing an intravenous cannula; SAB was tried in lateral position with quincke needle 23-gauge (B. During first attempt in L3–L4 interspace free flow of cerebrospinal fluid (CSF) was present but mixed with blood and not cleared off even after waiting for some time.

It was found that power in the left lower limb (LL) 1/5 and right LL 2/5 [Table 1].

Immediate Coagulation profile was; international normalized ratio (INR) - 2.3; prothrombin time - 27.6 s, activated partial thromboplastin time - 42 s. Spinal hematoma was probable diagnosis after exclusion of other probabilities.


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