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Disseminated intravascular coagulation as a complication of ventricular catheter placement. Case report
Insights
Disseminated intravascular coagulation (DIC) can occur after neurosurgery. Prompt treatment with fresh frozen plasma can effectively manage bleeding and prevent complications.
Area of Science:
- Pediatric Neurosurgery
- Hematology
- Coagulation Disorders
Background:
- Ventriculoperitoneal shunt placement is a common neurosurgical procedure in children.
- Disseminated intravascular coagulation (DIC) is a rare but serious complication associated with trauma and brain injury.
- The release of tissue thromboplastin from brain tissue can trigger DIC.
Observation:
- A child experienced generalized bleeding immediately after ventriculoperitoneal shunt placement.
- Laboratory tests confirmed evidence of disseminated intravascular coagulation (DIC).
- Complications included intraventricular hemorrhage and significant red cell volume loss.
Findings:
- Treatment with fresh frozen plasma led to rapid improvement in laboratory values.
- Bleeding ceased promptly following plasma infusion.
- This case highlights DIC as a potential complication of minor neurosurgical procedures.
Implications:
- Early diagnosis of DIC is crucial following any brain insult or neurosurgery.
- Prompt replacement of clotting factors can prevent severe hemorrhage and associated complications.
- Consideration of DIC in cases of excessive bleeding post-neurosurgery is warranted.
Abstract:
A child who developed generalized bleeding immediately after placement of a ventriculoperitoneal shunt was found to have evidence of disseminated intravascular coagulation (DIC). Infusion of fresh frozen plasma was followed promptly by improvement in laboratory values and cessation of bleeding. Complications of the acute bleeding episode included intraventricular hemorrhage, loss of 50% of the red cell volume into subcutaneous tissues, and transient peritoneal irritation. Defibrination syndrome (that is, DIC) due to release of tissue thromboplastin is a recognized complication of trauma, particularly with brain injury. Defibrination can be induced in experimental systems with administration of very small amounts of thromboplastin, which is present in high concentration in brain tissue. This has not been described previously with minor neurosurgical procedures. The diagnosis of DIC should be considered if excessive bleeding occurs after any brain insult, since early recognition and restoration of normal hemostasis by replacement of clotting factors should prevent major complications due to ongoing hemorrhage.