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<p>Haemoperitoneum has been documented in women with various bleeding disorders; however, there are few reports of this condition in patients with aplastic anaemia (AA). Here, we present a case of a patient with AA who developed an intraperitoneal hemorrhage accompanied by shock, managed successfully with intensive resuscitation and expert anaesthetic care. A 40-year-old female patient with a history of AA presented with abdominal distension and pain persisting for 7&#xa0;days. She had received inj. anti-thymocyte globulin therapy 8&#xa0;years ago and had been on oral danazol 100&#xa0;mg twice daily for the past year. On examination, the patient was found to be tachycardic with a heart rate of 144/min, hypotensive with a blood pressure of 62/30&#xa0;mmHg, and markedly pale. Laboratory investigations revealed a haemoglobin level of 3.5&#xa0;g/dL, platelet count of 4000/mm<sup>3</sup>, fibrinogen level of 232&#xa0;mg/dL, prothrombin time (PT) prolonged by 3&#xa0;s, and an international normalized ratio (INR) of 1.09. Urgent ultrasonography revealed a ruptured right ovarian cyst with severe hemoperitoneum. The patient was taken for emergency surgery under general anaesthesia, during which she was managed with multiple blood transfusions, antifibrinolytic therapy, and inotropic support. Rotational thromboelastometry (ROTEM) was not performed due to the unavailability of the machine. By the end of the procedure, her heart rate increased to 157&#xa0;bpm, attributed to volume depletion, while her blood pressure improved to 136/68&#xa0;mmHg with ongoing vasopressor support and multiple blood transfusion. Arterial blood gas analysis revealed pH: 7.21, PaO₂: 77&#xa0;mmHg and PaCO₂: 36&#xa0;mmHg. She was extubated on the operating table and had an uneventful recovery, being discharged on the 7th postoperative day. Hemoperitoneum is a potentially life-threatening emergency in patients with AA. Early diagnosis, prompt resuscitation with blood products and timely surgical intervention are critical to saving the patient’s life.</p>

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A Case of Aplastic Anaemia Resulting in Life-Threatening Intraperitoneal Ovarian Haemorrhage

  • 期刊论文

  • 发表日期：

    2025年6月7日

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  • Abhishek Mishra,
  • Shalendra Singh,
  • Neera Singh,
  • Aanchal Nayak

摘要

Haemoperitoneum has been documented in women with various bleeding disorders; however, there are few reports of this condition in patients with aplastic anaemia (AA). Here, we present a case of a patient with AA who developed an intraperitoneal hemorrhage accompanied by shock, managed successfully with intensive resuscitation and expert anaesthetic care. A 40-year-old female patient with a history of AA presented with abdominal distension and pain persisting for 7 days. She had received inj. anti-thymocyte globulin therapy 8 years ago and had been on oral danazol 100 mg twice daily for the past year. On examination, the patient was found to be tachycardic with a heart rate of 144/min, hypotensive with a blood pressure of 62/30 mmHg, and markedly pale. Laboratory investigations revealed a haemoglobin level of 3.5 g/dL, platelet count of 4000/mm3, fibrinogen level of 232 mg/dL, prothrombin time (PT) prolonged by 3 s, and an international normalized ratio (INR) of 1.09. Urgent ultrasonography revealed a ruptured right ovarian cyst with severe hemoperitoneum. The patient was taken for emergency surgery under general anaesthesia, during which she was managed with multiple blood transfusions, antifibrinolytic therapy, and inotropic support. Rotational thromboelastometry (ROTEM) was not performed due to the unavailability of the machine. By the end of the procedure, her heart rate increased to 157 bpm, attributed to volume depletion, while her blood pressure improved to 136/68 mmHg with ongoing vasopressor support and multiple blood transfusion. Arterial blood gas analysis revealed pH: 7.21, PaO₂: 77 mmHg and PaCO₂: 36 mmHg. She was extubated on the operating table and had an uneventful recovery, being discharged on the 7th postoperative day. Hemoperitoneum is a potentially life-threatening emergency in patients with AA. Early diagnosis, prompt resuscitation with blood products and timely surgical intervention are critical to saving the patient’s life.