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  • Title: Two cases of myomectomy complicated by intravascular hemolysis and renal failure: disseminated intravascular coagulation or hemolytic uremic syndrome?
    Author: Tsimpanakos I, Connolly J, Alatzoglou KS, Rowan C, Magos A.
    Journal: Fertil Steril; 2010 Apr; 93(6):2075.e11-5. PubMed ID: 20056203.
    Abstract:
    OBJECTIVE: To present two cases of myomectomy complicated by intravascular hemolysis leading to acute renal failure and discuss the differential diagnosis and possible mechanism. DESIGN: Case report. SETTING: Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynecology. PATIENT(S): Two premenopausal patients with uterine fibroids. INTERVENTION(S): Both patients underwent otherwise uncomplicated myomectomies, one by laparotomy and one by laparoscopy, with tourniquets around the uterine and ovarian vessels being used to control intraoperative bleeding. MAIN OUTCOME MEASURE(S): Renal function in the postoperative period. RESULT(S): Both patients developed a very rare complication after surgery of severe thrombocytopenia with microangiopathic hemolytic anemia leading to acute renal failure. One patient made a full recovery within weeks but the other still has reduced renal function almost 2 years after the surgery. The differential diagnosis consisted of disseminated intravascular coagulation or hemolytic uremic syndrome. CONCLUSION(S): The etiology of thrombotic microangiopathy in these patients was unclear, but disruption and manipulation of fibroids during surgery may have led to the dissemination of pro-coagulant tissue factor containing particles leading to disseminated intravascular coagulation or hemolytic uremic syndrome, perhaps aggravated by utero-ovarian ischemia caused by the tourniquets.
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