Successful Pericardiocentesis for Cardiac Tamponade in a Patient with Thrombocytopenic Acute Lymphocytic Leukemia

Abstract

We evaluated a 22-year-old patient complaining of acute breathlessness and pretibial edema in relapsed and refractory acute lymphoblastic leukemia (ALL). The patient was under rituximab-cyclophosphamide, vincristine, dexamethasone, doxorubicin (R-HCVAD) alternating with R-rituximab, methotrexate-cytarabine (MTX-ARAC) chemotherapies and he had a pancytopenia including severe thrombocytopenia. On his physical examination: The heart rate was 120 beats/min with evidence of pulsus paradoxus and the blood pressure was 85/60 mmHg. The jugular venous pressure was elevated up to the angle of the jaw. The cardiac apex was ill-defined and heart sounds were faint. There was no murmur or pericardial friction rub. He had severe pretibial edema because of hypoalbuminemia and acute right ventricular dysfunction observed by echocardiography. Electrocardiography revealed a poor R wave progression in all pre-

Pericardiocentesis in patients with thrombocytopenia and high international normalized ratio: Case report and review of the literature

“…However, literature data regarding the feasibility of pericardiocentesis in patients with uncorrected bleeding diathesis are limited. There are only several case reports all of which demonstrated that pericardiocentesis is safe and effective in subjects with thrombocytopenia [3][4][5][6]. Moreover to our knowledge, pericardiocentesis in the setting of both thrombocytopenia and high INR has not been reported previously.…”