Acute Onset of Coagulopathy in a Patient with Kasabach-Merritt Syndrome following Transurethral Resection of Bladder Tumor

Abstract

We report an unusual case of Kasabach-Merritt syndrome in a 62 year-old woman with bladder tumor who suffered from acute consumption coagulopathy that increased the fibrinolytic activity due to the presence of a huge hemangioma in the upper and lower extremities. Two days after the transurethral resection of the solitary bladder tumor, serious hematuria and life-threatening disseminated intravascular coagulation developed. Following treatments with heparin and subsequent steroid treatment, hemorrhage and abnormal hemostatic values improved. It is suggested that extensive investigation of the coagulation system should be done in patients with giant hemangioma, particularly before a surgical procedure.

Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome

“…Heparin was effective in a 62‐year‐old woman with extensive VM of the extremities (misdiagnosed as giant haemangioma) and severe bleeding after excision of a bladder tumour. Corticosteroid treatment was used also but was probably unnecessary (Shoji et al ., 1998). In our experience, heparins with lower molecular weights are more effective: we obtained the greatest benefits using CY222, an ultra‐LMWH that is not commercially available (Drouet et al.…”

“…The purpose of this retrospective study of 24 patients with diffuse limb venous malformations (VMs) was to illustrate the characteristics of VM‐associated coagulation disorders, to establish guidelines for management, and to differentiate this situation from KMS with the goal of avoiding further misdiagnosis and mismanagement (Straub et al ., 1972; Mewes et al ., 1989; Maceyko & Camisa, 1991; Shoji et al ., 1998; Hall, 2001).…”

Treatment of Kasabach–Merritt syndrome: a stepwise regimen of prednisolone, dipyridamole, and interferon

“…Biopsy in one other patient indicated cavernous hemangioma. Although most cases of KMS started in infancy, KMS has been reported in all ages, 1–10 including adult cases with Klippel–Trenaunay–Weber syndrome in pregnancy, 11,12 and hemangioma following transurethral resection of a bladder tumor 13 . Therefore, we believed that KMS can be associated with a variety of vascular tumor 1,7 …”

“…Cryoprecipitate (5–10 mL/kg) and fresh frozen plasma (5 mL/kg) may be helpful in the management of bleeding patients with severe uncontrolled consumptive coagulopathy. A variety of treatments have been used to induce tumor regression, including prednisolone, 1,4 , 6 dipyridamole, 14 fentoxyfylline, 1 ticlopedine, 1 heparin, 1 IFN, 13 vincristine, 1 radiotherapy, 1,16 , 17 and embolization of the feeding vessel to the tumor 1,6 …”

Kasabach-Merritt-Syndrom bei Riesenhämangiom der Leber Ein Fallbericht

“…Hier wurde es z. B. ausgelöst durch große Hämangiome in den Extremitäten [16], der Leber [6,7,9,19], der Parotis [18] oder durch ein Hämangiosarkom der Brust [8].…”