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Retroperitoneal Hemorrhage in Patients with COVID-19 Undergoing Hemodialysis: Three Case Reports
Hideaki Oka1, Yoshito Homma2, Yuki Nishino3
1Division of Kidney Center, Matsuyama Red Cross Hospital, Japan.
Insights
Patients with COVID-19 on hemodialysis and antiplatelets face bleeding risks, particularly with anticoagulants like heparin. Careful monitoring for hemorrhage is crucial for managing these severe complications.
Area of Science:
- Nephrology
- Infectious Diseases
- Interventional Radiology
Background:
- Patients undergoing hemodialysis often receive antiplatelet therapy.
- COVID-19 infection can necessitate anticoagulation, increasing bleeding risks.
- Hemorrhagic complications pose a significant threat in this patient population.
Observation:
- Three cases of patients on hemodialysis and antiplatelets admitted with COVID-19 are presented.
- Two patients developed iliopsoas/iliacus hemorrhage after heparin initiation.
- One patient experienced gastrointestinal bleeding and subsequent iliopsoas hemorrhage despite anticoagulation adjustments.
Findings:
- Hemorrhagic complications, including iliopsoas and gastrointestinal bleeding, occurred in patients with COVID-19 undergoing hemodialysis.
- Anticoagulation with heparin was associated with hemorrhage in two cases.
- Despite interventions, severe bleeding and infectious complications led to mortality in two patients.
Implications:
- There is a critical need for heightened awareness and vigilant monitoring of hemorrhagic complications in COVID-19 patients, especially those on hemodialysis.
- Management strategies must carefully balance the risks of thrombosis and bleeding.
- Interventional radiology plays a vital role in managing these severe bleeding events.
Abstract:
A 73-year-old man receiving hemodialysis and antiplatelets was admitted with a mild case of COVID-19. Heparin was added, and iliopsoas hemorrhage developed. He was successfully treated by interventional radiology. A 76-year-old man receiving hemodialysis and antiplatelets was admitted with mild COVID-19. Heparin was added, and iliacus hemorrhage developed. Despite heparin discontinuation, he died of worsening pneumonia. A 74-year-old man undergoing hemodialysis was admitted with severe COVID-19. Gastrointestinal bleeding developed during continuous hemodiafiltration with heparin. Upon switching to nafamostat and increasing the dose, iliopsoas hemorrhage developed. Despite interventional radiology, he died of infectious complications. Attention to hemorrhagic complications is therefore needed in patients with COVID-19.
