POINT-OF-CARE DIAGNOSTIC APPROACH IN A CRITICALLY ILL PATIENT WITH SEVERE BLEEDING FROM URINARY TRACT

• Published in: Acta clinica Croatica (Tisak) Vol. 62; no. Suppl2; pp. 138 - 142
• Main Authors: Škiljić, Sonja, Nešković, Nenad, Kristek, Gordana, Milić, Marija, Vinković, Hrvoje, Kedačić, Karlo, Kvolik, Slavica
• Format: Journal Article
• Language: English
• Published: Croatia Sestre Milosrdnice University Hospital and Institute of Clinical Medical Research, Vinogradska cesta c. 29 Zagreb 01.07.2023; Sestre Milosrdnice University hospital, Institute of Clinical Medical Research
• Subjects: Aged; Amiodarone; Bleeding; Blood coagulation disorders; Blood Coagulation Tests - methods; Case Reports; Critical Illness; Drug-related side effects and adverse reactions; Hematuria - diagnosis; Hematuria - etiology; Hematuria - therapy; Humans; Lithotripsy; Male; Platelet aggregation; Point-of-Care Systems; Point-of-Care Testing; Surgical hemostasis; Drug-related side effects and adverse reactions; Surgical hemostasis; Blood coagulation tests; Amiodarone; Platelet aggregation; Bleeding; Blood coagulation disorders
• ISSN: 0353-9466; 1333-9451; 1333-9451
• DOI: 10.20471/acc.2023.62.s2.20

Coagulation disorders in critically ill patients presenting with bleeding can be multicausal. The drugs applied can interfere and impair the coagulation cascade. Point-of-care (POC) coagulation assays may resolve difficult therapeutic situations in critical illness. We report on a 73-year-old critically ill male patient with massive hematuria after bladder lithotripsy. The patient was on low molecular weight heparin therapy due to recent pulmonary embolism. He was subjected to repeated surgical hemostasis which was ineffective despite massive transfusion protocol and normal standard coagulation profile. Additional POC coagulation assays were obtained and were indicative of platelet dysfunction. We revised his medical therapy and suspected the possible drug influence on platelet aggregation. After discontinuation of target drug, platelet aggregation increased whereas hematuria stopped. Coagulation disorders in intensive care unit patients are often multifactorial. Standard laboratory tests are unreliable in complex refractory bleeding and may result in inappropriate therapeutic decisions. Stepwise approach with assessment of clinical parameters, present therapy, and a combination of POC coagulation tests is the key to optimal therapeutic management.