An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma (Figure). The patient underwent decompressive laminectomy of T12-L1. Spontaneous epidural hematoma is a rare ...

Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. The patients are sensitive to their own red blood cells injected intradermall...

Severe coagulopathies can occur during liver transplantation, particularly after reperfusion of the grafted liver. Heparin release has been proposed as one of the factors contributing to this coagulopathy. We have analysed the thrombelastograph (TEG) traces of 55 patients after reperfusion using native and heparinase-treated samples. In almost all cases an abnormal native TEG was improved in vi...

Method Total 150 patients were enrolled in this double-blind, randomized, placebo-controlled, prospective clinical trial scheduled for primary isolated off pump coronary artery bypass grafting, divided in 2 groups (each group consisting of 100 patients). Patients with coagulopathies, renal failure, re-do surgery, or recent anti-platelet treatment were excluded. Tranexamic acid (TA) group (75 pa...

Chicken pox is a self-limited exanthematous disease that primarily affects children. Varicella zoster virus (VZV) has been considered to be the causative agent. VZV infections manifest as varicella and herpes zoster usually cause mild infections, without any severe complications in immunocompetent children [1]. However, in certain individuals with immunocompromised status, the infection may sho...

EDITOR: Thromboelastograph (TEG) displays the viscokinetic properties [1] of the clot formed, which in turn reflects the functions of different factors involved in the coagulation process [2] and also the interaction between these factors. TEG is considered to be better than the conventional coagulation tests [3] and is becoming more popular among perioperative clinicians in managing coagulopat...

Conventional nasal packs, including BIPP (bismuth iodine paraffin paste), merocel or kaltostat are usually used to pack the nasal cavity while the coagulopathies are corrected. However, the coagulation profile can be rather difficult to correct in patients with haematological malignancies e.g. leukaemia. Thrombocytopenia or low platelet count is usually the commonest coagulopathy and can be res...

Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82-year-old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction,...

A 45-year-old woman presented with sudden severe excruciating headache. Medical history disclosed intermittent fever and weight loss in the past 3 months. No focal neurological deficits were seen. CT scan disclosed diffuse subarachnoid hemorrhage. Cranial CT angiography showed no intracranial aneurysms (Figure). Laboratory evaluation disclosed thrombocytopenia, anemia and abnormalities of white...

Visceral leishmaniasis (VL), also known as Kala-azar, is a systemic infection caused by a protozoan (Leishmania) and, in its classic form, is a serious illness associated with malnutrition, anemia, hepatosplenomegaly, infectious processes and coagulopathies. The effect of splenectomy in patients with visceral leishmaniasis is not well defined; however, it is known that the spleen is the largest...