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Endogenous Heparinoids May Cause Bleeding in Mucor Infection and can be Detected by Nonactivated Thromboelastometry
Miroslav Durila1, Petr Pavlicek, Ivana Hadacova
1From the Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol (MD, PP), Department of Clinical Haematology, Motol University Hospital (IH), Department of Paedriatric Surgery (JN), and Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (DJ).
Abstract:
Mucormycosis is an aggressive fungal infection, which invades endothelial cells of blood vessels. This condition might lead to destruction of endothelium and release of heparin-like substances to the bloodstream and cause life-threatening bleeding, which is not well described in the literature.We present a patient with mucormycosis who experienced life-threatening bleeding, although no standard laboratory test could detect any coagulopathy.The cause of bleeding-coagulopathy was detected only by nonactivated thromboelastometry (NATEM), which revealed the presence of heparin-like substances. After treatment with recombinant activated FVII rotational thromboelastometry, results improved and the patient stopped bleeding. Regular application of the drug was necessary during acute phase of infection to prevent further bleeding.In this case report, we show that NATEM can detect the presence of heparin-like substances in bleeding patient with mucormycosis infection and that recombinant activated FVII can be used to stop and prevent bleeding until infection resolves.
Insights
Mucormycosis infection can cause severe bleeding due to heparin-like substances, detectable by nonactivated thromboelastometry (NATEM). Recombinant activated FVII effectively treated this life-threatening coagulopathy.
Area of Science:
- Medical Mycology
- Hematology
- Critical Care Medicine
Background:
- Mucormycosis is an aggressive fungal infection that invades blood vessel endothelium.
- This invasion can lead to endothelial destruction and release of heparin-like substances, causing severe bleeding not well-documented in literature.
Observation:
- A patient with mucormycosis presented with life-threatening bleeding.
- Standard laboratory coagulation tests did not detect any coagulopathy.
- Nonactivated thromboelastometry (NATEM) identified heparin-like substances as the cause of bleeding.
Findings:
- NATEM successfully detected heparin-like substances in a bleeding mucormycosis patient.
- Treatment with recombinant activated FVII (rFVIIa) improved thromboelastometry results and stopped bleeding.
- Continuous rFVIIa administration was required during the infection's acute phase to prevent recurrent bleeding.
Implications:
- NATEM is a valuable tool for diagnosing obscure coagulopathies in mucormycosis.
- Recombinant activated FVII is a potential therapeutic agent for managing bleeding in mucormycosis-associated coagulopathy.
- This case highlights a critical, underreported complication of mucormycosis and its effective management.
