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Anesth Pain Med > Volume 10(4); 2015 > Article
Transplantation Anesthesia
Anesthesia and Pain Medicine 2015;10(4):295-300.
DOI: https://doi.org/10.17085/apm.2015.10.4.295    Published online October 31, 2015.
Sudden cardiovascular collapse after platelet transfusion during liver transplantation: flat-line thromboelastometry and inferred pulmonary thromboembolism: A case report
In Young Huh, Sun Kee Kim, Ha Jung Kim, Hyung Joo Chung, Gyu Sam Hwang
1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
2Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kshwang@ amc.seoul.kr
Received: 9 April 2015   • Revised: 25 April 2015   • Accepted: 18 June 2015
Abstract
Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.
Key Words: Liver transplantation, PTE, ROTEM
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