Leech bites: massive bleeding, coagulation profile disorders, and severe anemia

Leeches have been in use for centuries, especially in plastic and reconstructive surgery wound and flap healing, in venous insufficiencies, and in the treatment of many disorders such as hemorrhoids and varicosity. With this study, we aimed to discuss coagulation disorder due to uncontrolled leech bites, consequent excessive skin hemorrhage, and anemia requiring blood transfusion. A 65-year-old male patient was referred to the emergency department because of excessive intractable bleeding that had occurred after leech bites. On physical examination, a total of 130 bites were detected on various regions of the body. In the laboratory findings of the patient, hemoglobin and hematocrit levels were extremely low, and prothrombin time, international normalized ratio, and partial thromboplastin time were markedly increased. The patient received a total of 8 units of fresh frozen plasma and 6 units of erythrocyte suspension. Bleeding stopped by decreasing after the transfusion of fresh frozen plasma. Although the complications due to leech injuries are rare, they may be an important cause of morbidity and mortality when an injury or prolonged bleeding in an internal region occurs. Prolonged skin hemorrhages rarely cause anemia, and deaths are caused by intractable hemorrhages. However, a coagulation disorder and consequent intractable hemorrhage have not been reported previously in the literature. In conclusion, it should be known that uncontrolled, blind, and excessive leech use causes severe hemorrhage and excessive blood loss, causing significant morbidity and mortality. Therefore, the awareness of either physicians or people using or recommending alternative medicine should be raised on this subject.