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Marcela Moreno, Eduardo Najar
Latin Agency for News Medicine and Public Health
The development of clots tends to occur in some systems of the body, however very rarely they are directed to other areas
A strange case that has dismayed health workers for an elderly patient who presents an unusual case of haemophilia, where the clots that have developed have affected the circulatory system and malignant neoplasms have developed in a place that for the literature presents itself as very few and rare ways , the bladder.
At first, the clinical picture suggests hematuria, a condition that is affected by the presence of blood in the sphincter fluids, an early diagnosis that could direct doctors to more accurate treatment and find the reason for this irregularity.
In an interview with the Journal of Medicine and Public Health (MSP), Dr. Nelky Rivera Acosta, family physician, explained how those clotting factors can be present in an elevated way, taking into account specific criteria that can regulate these associated anomalies.
“I was bleeding from the urine for four days. The first time I saw her she had already received an antibiotic, but it hasn’t improved, the bleeding in the urine can sometimes be due to infections, but it hasn’t improved. After noticing this, a catheter was placed, an abdominal-pelvic exam was performed in which it was found that he had blood in his bladder, showed bleeding in the kidney collection system and had clots in his bladder, due to this he entered the emergency department to be evaluated by the urologist ”, explained the specialist.
During the medical procedure, hemoglobin and coagulation factors such as PTT were evaluated in laboratories, which in her case showed an increase of 84.1, with a normal range of 22.7 to 37.7.
The INR, which is another of the coagulation factors, in the patient’s case was 1.16, the hemoglobin was at 7.9 and the platelets at 193, considered normal, so the disturbance focuses on PTT coagulation, which recorded 84.2, outside of normal parameters, according to Dr. Rivera. “When we realized that the PTT was so severely elevated at 84.2 we had to consult her with the hematologist, as this is unusual and this patient was decompensating too quickly. More laboratories were carried out to find out why this PTT was so high despite having been given blood transfusions, but despite this the bleeding remained, ”he stressed.
The strange thing about the case was the presence of antibodies that were attacking factor eight and this is what acquired hemophilia A refers to. The production of antibodies that attack factor eight is a case that occurs in 1 in 1000 patients, according to the literature.
For the treatment of this 75-year-old patient, high doses of steroids, anti-cephaemolytic drugs used to stop bleeding in mucocutaneous areas, bleeding from the urine, and to stop bruising on the body should it occur. Despite all the efforts of the medical team, the uncontrolled bleeding led to the patient’s arrest.
Despite the specific treatments that reduce clots, the control of bleeding that was not in time was fatal and ended with his life, for this reason the request for attention is to take into account these signs in order to establish an early diagnosis in this type of irregularity.
“It is important to perform coagulation laboratory tests, in order to determine the expected diagnosis from the first moment, it is essential to perform this type of tests in some haemorrhagic pictures, especially in those of advanced age, since it is necessary to be suspicious of that abnormalities nature occur to save lives ”, concluded the doctor.
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