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Dear Editor, Renal cell carcinoma (RCC) is associated in up to 20% of the emergence of paraneoplastic syndromes, being sometimes the first clinical outcome. Hepatic dysfunction in nonmetastatic RCC patients was first described by Stauffer in 1961 and can be categorized as a non-specific hepatitis with coagulation time extension, increased cholestasis enzymes, and even hyperbilirubinemia [1]. In most cases, analytical alterations are normalized after the surgery attributing the paraneoplastic syndrome to cytokines synthesized by the own tumour.In the most recent literature, the information about this dysfunction [2] and its perioperative management is very limited. Because of its uniqueness and its impact on the haemostasis, it seemed very interesting for us to describe the case of a patient subjected to laparoscopic nephrectomy due to a RCC and Stauffer syndrome, in which the use of prothrombin complex achieved an effective haemostasis.A 70-year-old, 80-kg woman was submitted for laparoscopic left nephrectomy due to an RCC. Her personal background includes arterial hypertension, treated with enalapril, NIDD in antidiabetic oral therapy and breast tumour intervened in 2004, actually in complete remission. Preoperative laboratory tests reveal a polyclonal hypergammaglobulinemia, 10.3 total bilirubin (TBIL) [normal value (nv) 0.20-1.20 mg/dL] in expense of direct bilirubin 9.2 (nv 0.00-0.30 mg/dL), AST 672 (nv 5-31 IU/L), ALT 397 (nv 5-31 IU/L), GGT 507 (nv 7-32 IU/L), ALP 222 (nv 35-104 IU/L), PT 30% (nv 75-100%), APTT 40 (vn 21-35 s), INR 2.04 (nv 0, 8-1, 2) and haemoglobin value of 12.8 g/dL; other blood parameters were rigorously normal. Twenty-four hours prior to the surgery, 30 mg of vitamin K was administrated. The surgery went along without incidents, and the patient did not require blood transfusion. Once in the postsurgical intensive care unit (PICU), the postoperative clotting study showed a haemoglobin value of 11.6 g/dL, PT 26%, APTT 50 s and INR of 2.5 with normal fibrinogen levels, but within 3 h from arrival, bleeding, without hemodynamic instability, through the surgical drainage and trocar incisions was objected.Given the underlying liver dysfunction and the urgent need to limit the bleeding as quickly as possible, 25 IU/kg of prothrombin complex (Octaplex®; Octapharma S.A., Madrid) was administrated, ceding the bleeding, without blood transfusion, and with an INR value 45 min after the administration lower than 2. The patient left the PICU with an haemoglobin value of 8.3 g/dL, PT 44%, APTT 35 s and INR 1.6 with platelet counting of 137,000/mL. Fifteen days after the surgery, the hepatic dysfunction parameters were practically normalized, with a 1.30 mg/dL TBIL, AST 110 IU/L, ALT 97 IU/L, PT 79%, APTT 35 s and INR 1.4. Despite the paraneoplastic status of this entity, there were no thrombotic adverse events in our patient.Octaplex is a new prothrombin complex concentrate (PCC) that is indicated in the perioperative prophylaxis, and in the treatment, of bleeding in patients with a prothrombin compl...

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