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Internal Bleeding Extending to the Retroperitoneum and Right Psoas With Severe Acute Respiratory Syndrome Coronavirus

Sarah Hatahet1, Magdi S Yacoub2, Mina Farag3

  • 1Internal Medicine, University of Novi Sad, Novi Sad, SRB.

Cureus
|November 10, 2021
PubMed

Insights

Severe COVID-19 patients on anticoagulation face bleeding risks. A Jehovah's Witness experienced a near-fatal bleed, highlighting the need for careful risk assessment and transfusion alternatives.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to coagulopathy and thromboembolic events.
  • Anticoagulant use has increased significantly in managing COVID-19 patients.
  • Bleeding complications are a known adverse effect of anticoagulation therapy.

Observation:

  • A 60-year-old male with severe COVID-19 requiring ICU admission and mechanical ventilation developed a retroperitoneal hemorrhage.
  • The patient, a Jehovah's Witness, refused blood transfusions, complicating management.
  • The bleed resulted in a 50% drop in hemoglobin levels.

Findings:

  • Anticoagulation in critically ill COVID-19 patients carries a substantial risk of potentially fatal bleeding events.
  • Management protocols for anticoagulation in SARS-CoV-2 infection vary.
  • Individualized risk-benefit analysis of anticoagulation is crucial.

Implications:

  • Early detection and intervention for bleeding are vital in COVID-19 patients on anticoagulation.
  • Clinicians must consider alternatives to blood transfusion when managing hemorrhage in patients who refuse transfusions.
  • Balancing the risks of thrombosis and bleeding is essential for optimal patient outcomes.

Keywords:
complications of anticoagulationcovid-19 associated coagulopathyjehovah's witnessretroperitoneal bleedsars-cov-2

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