Paradoxical pulmonary hemorrhage associated with hemocoagulase batroxobin in a patient with hemoptysis

摘要

RATIONAL:Hemocoagulase, a hemostatic, is used in patients with trauma, gastrointestinal bleeding, or pulmonary hemorrhage or those undergoing surgery. However, paradoxical bleeding after hemocoagulase administration is not considered a clinically significant adverse effect. Here, we report a case of paradoxical pulmonary hemorrhage associated with hypofibrinogenemia after administration of the hemocoagulase batroxobin in a patient with hemoptysis.PATIENT CONCERNS:An 86-year-old woman complained of hemoptysis during hospitalization with organophosphate poisoning. Hemocoagulase was administered to manage bleeding; however, bleeding signs, such as hemoptysis, massive epistaxis, and ecchymosis, recurred.DIAGNOSES:The patient was diagnosed with acquired hypofibrinogenemia on the basis of the reduced plasma fibrinogen level after hemocoagulase administration and lack of other causes of bleeding.INTERVENTION:Hemocoagulase administration was discontinued, and fibrinogen-containing plasma products were administered.OUTCOMES:The plasma fibrinogen level normalized and bleeding signs did not recur.LESSONS:It is necessary to measure plasma fibrinogen levels regularly in patients undergoing hemocoagulase administration and discontinue its administration when acquired hypofibrinogenemia is detected.Copyright ? 2021 the Author(s). Published by Wolters Kluwer Health, Inc.