URETERAL COLIC SECONDARY
TO BLOOD
CLOT IN HEMOPHILIAC STARLING BENJAMIN
C. EVINS,
M.D.
K. McINNES,
M.D.
From the Department of Urology, Medical University of South Carolina, Charleston, South Carolina
ABSTRACT - Cryoprecipitate therapy replaces necessary clotting factors in a patient with factor Vlll deficient hemophilia. In such a patient with hematuria, cryoprecipitate therapy can initiate the formation of a massive blood clot in the urinary collecting system. A case is reported of a factor VIII-deficient hemophiliac in whom ureteral colic and poor function of the right kidney developed because of a blood clot formed shortly after cryoprecipitate therapy.
The hemophiliac patient and his physician must learn to live with the many complications of hemophilia. Fortunately, some complications will clear spontaneously in the patient on a cryoprecipitate regimen, and it is often best to resist the temptation to intervene surgically. An example of such a case is reported.
FIGURE 1. Urograms: (A) preadmission, normal findings.
650
Case Report A sixteen-year-old, factor VIII-deficient hemophiliac went to his family physician for his weekly infusion of 10 packs of cryoprecipitate.
shows poor function
of right kidney, and (B)postadmission, shows
UROLOGY
/
JUNE 1979
/
VOLUME
XIII,
NUMBER
6
The patient was having gross hematuria at the time the cryoprecipitate was infused. Shortly after receiving the cryoprecipitate, right flank pain compatible with right renal colic developed. This colicky type of pain persisted for the next five days, and an excretory urogram was obtained. Urogram showed poor function of the right kidney (Fig. lA), and the patient was referred to the urologic service of the medical university hospital. While in transit, the patient passed several blood clots per urethra, and the ureter-al colic subsided. A repeat urogram done the day after admission showed normal findings (Fig. 1B). Comment A review of the recent literature was unproductive concerning the incidence of ureteral colic precipitated by the administration of cryoprecipitate in a hemophiliac with hematuria. No data were available on how much cryo-
UROLOGY
/ JUNE 1979
/ VOLUME
XIII,
NUMBER
6
precipitate, if any, is filtered by the glomerulus into the collecting system. In a situation such as this, however, glomerular filtration of the cryoprecipitate might be unnecessary. Enough of the factor VIII to produce clotting might simply enter the collecting system at the site of active bleeding. Hypothetically, this patient had a relatively large volume of blood in his collecting system at the time cryoprecipitate was being administered. The factor VIII entered the collecting system either by glomerular filtration or through an actively bleeding vessel and produced a clot by interaction with the blood in the collecting system. The clot, in turn, produced ureteral obstruction resulting in colic and poor function of the kidney. 1325 Carter’s Creek Pike Franklin, Tennessee 37064 (DR. EVINS)
651
TO BLOOD
CLOT IN HEMOPHILIAC STARLING BENJAMIN
C. EVINS,
M.D.
K. McINNES,
M.D.
From the Department of Urology, Medical University of South Carolina, Charleston, South Carolina
ABSTRACT - Cryoprecipitate therapy replaces necessary clotting factors in a patient with factor Vlll deficient hemophilia. In such a patient with hematuria, cryoprecipitate therapy can initiate the formation of a massive blood clot in the urinary collecting system. A case is reported of a factor VIII-deficient hemophiliac in whom ureteral colic and poor function of the right kidney developed because of a blood clot formed shortly after cryoprecipitate therapy.
The hemophiliac patient and his physician must learn to live with the many complications of hemophilia. Fortunately, some complications will clear spontaneously in the patient on a cryoprecipitate regimen, and it is often best to resist the temptation to intervene surgically. An example of such a case is reported.
FIGURE 1. Urograms: (A) preadmission, normal findings.
650
Case Report A sixteen-year-old, factor VIII-deficient hemophiliac went to his family physician for his weekly infusion of 10 packs of cryoprecipitate.
shows poor function
of right kidney, and (B)postadmission, shows
UROLOGY
/
JUNE 1979
/
VOLUME
XIII,
NUMBER
6
The patient was having gross hematuria at the time the cryoprecipitate was infused. Shortly after receiving the cryoprecipitate, right flank pain compatible with right renal colic developed. This colicky type of pain persisted for the next five days, and an excretory urogram was obtained. Urogram showed poor function of the right kidney (Fig. lA), and the patient was referred to the urologic service of the medical university hospital. While in transit, the patient passed several blood clots per urethra, and the ureter-al colic subsided. A repeat urogram done the day after admission showed normal findings (Fig. 1B). Comment A review of the recent literature was unproductive concerning the incidence of ureteral colic precipitated by the administration of cryoprecipitate in a hemophiliac with hematuria. No data were available on how much cryo-
UROLOGY
/ JUNE 1979
/ VOLUME
XIII,
NUMBER
6
precipitate, if any, is filtered by the glomerulus into the collecting system. In a situation such as this, however, glomerular filtration of the cryoprecipitate might be unnecessary. Enough of the factor VIII to produce clotting might simply enter the collecting system at the site of active bleeding. Hypothetically, this patient had a relatively large volume of blood in his collecting system at the time cryoprecipitate was being administered. The factor VIII entered the collecting system either by glomerular filtration or through an actively bleeding vessel and produced a clot by interaction with the blood in the collecting system. The clot, in turn, produced ureteral obstruction resulting in colic and poor function of the kidney. 1325 Carter’s Creek Pike Franklin, Tennessee 37064 (DR. EVINS)
651
