Respir Case Rep. 2023; 12(2): 75-80 | DOI: 10.5505/respircase.2023.37268

Life-threatening Hemorrhagic Conditions in COVID-19 Patients in the Intensive Care Unit: A Case Series

Hatice Kutbay Ozcelik, Nazan Beyhan, Esra Akkutuk Ongel, Özkan Devran
Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Ýstanbul, Türkiye

The COVID-19 pathology is characterized by thromboinflammatory events at a microvascular level in the lung and other organs. In an assessment of patients with severe COVID-19 pneumonia requiring intensive care, we identified cases in which life-threatening hemorrhage was encountered after the administration of therapeutic/prophylactic-dosage low molecular weight heparin according to guidelines. Among the identified cases, three were male, two female and all patients were administered anticoagulation admin-istrations. All patients with suspected bleeding were identified with severely low hemoglobin levels. Retroperitoneal hematomas were detected in four of the five patients, one of whom was diagnosed based on clinical suspicion, while others were confirmed via imaging. One patient died due to hemorrhage, while the hemorrhages of other patients were controlled through the discontinuation of anticoagulant therapy and appropriate blood product transfusions. While administering anticoagulant therapy for COVID-19 pneumonia in patients followed in the intensive care unit, attention should be paid to the issue of bleeding, and the potential for such rare but life-threatening complications as retroperitoneal hematoma.

Keywords: COVID-19, retroperitoneal hematoma, anticoagulant therapy, bleeding

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Yoðun Bakým Ünitesinde COVID-19 Hastalarýnda Hayatý Tehdit Eden Hemorajik Durumlar: Olgu Serisi

Hatice Kutbay Ozcelik, Nazan Beyhan, Esra Akkutuk Ongel, Özkan Devran
Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Ýstanbul

COVID-19 patolojisi; akciðer ve diðer organlarda mikrovasküler seviyede tromboinflamatuvar olaylar ile karakterizedir. Yoðun bakým gerektiren aðýr COVID-19 pnömonili hastalara kýlavuzlara göre terapötik/profilaktik dozda düþük moleküler aðýrlýklý heparin uygulamasýndan sonra karþýlaþýlan hayatý tehdit eden kanama olgularýný derledik. Olgularýn üçü erkek, ikisi kadýndý ve hepsine antikoagülasyon uygulandý. Ka-nama þüphenilen hastalarýn hepsinde ciddi hemoglobin düþüklüðü mevcuttu. Biri klinik þüphe ile taný konulan, diðerleri görüntüleme yöntemleri ile kesinleþen 5 hastanýn dördünde retroperitoneal, birinde iliopsoas kasý içinde hematom tespit edildi. Bir hasta hemoraji nedeniyle kaybedilirken, diðer hastalarýn hemorajileri antikoagülan tedavinin sonlandýrýlmasý, uygun kan ürünü transfüzyonlarý ile kontrol altýna alýndý. Yoðun bakým ünitesinde takip edilen COVID-19 pnömonili olgularda antikoagülan tedavi verilirken kanama açýsýndan dikkatli olunmalý ve hastalar vital bulgular ve laboratuvar bulgularý ile sýk monitorize edilmeli, retroperitoneal hematom gibi nadir ancak hayatý tehdit edebilecek komplikasyonlar akýlda tutulmalýdýr.

Anahtar Kelimeler: COVID-19, retroperitoneal kana-ma, antikoagulan tedavi, kanama

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