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20 November 2013 : Case report  Malaysia

Retroperitoneal hemorrhage associated with bone marrow trephine biopsy

Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)

Wan Fariza Wan JamaludinBDEF, Shahizon Azura Mohamed MukariDE, S. Fadilah Abdul WahidBDEF

DOI: 10.12659/AJCR.889274

Am J Case Rep 2013; 14:489-493

Abstract

Background: Bone marrow (BM) trephine biopsy is generally a safe procedure, but adverse events such as retroperitoneal hemorrhage (RPH) may occur. We report 3 cases of this complication.
Case Report: A 19-year-old male with thrombocytopenia and coagulopathy underwent BM trephine biopsy to confirm relapse of acute lymphoblastic leukemia. Two hours later, he developed severe hypotension and a CT scan revealed a massive RPH, and was treated conservatively. The RPH recurred 2 weeks after chemotherapy and was successfully treated with gel foam embolization. A 55-year-old male with coagulopathy underwent BM trephine biopsy for hyperleukocytosis and thrombocytosis. He developed a large RPH preceded by left lumbar dermatome sensory neuropathy. He was treated conservatively. A 56-year-old overweight woman on aspirin underwent BM trephine biopsy for polycythemia. Twelve hours later she developed severe abdominal pain with hypotension. A CT scan showed a massive RPH and secondary hemothorax. She was treated conservatively and the RPH resolved after several months.
Conclusions: We and others showed that myeloproliferative neoplasm, quantitative or qualitative platelet abnormalities, aspirin, coagulopathy, and obesity are associated with development of RPH following BM trephine biopsy. Early diagnosis and intervention are crucial. Correction of coagulopathy and cessation of anti-platelet treatment prior to biopsy can prevent this serious complication.

Keywords: retroperitoneal hematoma, retroperitoneal hemorrhage, Bone marrow trephine biopsy

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923