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The Journal of Bone and Joint Surgery 79:1391-4 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Case Report

Coagulopathy Complicating Intraoperative Blood Salvage in a Patient Who Had Idiopathic Scoliosis. A Case Report*

JOHN S. McKIE, M.B.CH.B., F.R.A.C.S.{dagger} and JOHN E. HERZENBERG, M.D., F.R.C.S.(C){ddagger}, BALTIMORE, MARYLAND

Investigation performed at the University of Maryland Medical School, Baltimore


   Introduction
 
Techniques that have been designed to avoid the use of homologous blood, including preoperative donation of autologous blood and intraoperative blood salvage, are now commonly employed in major orthopaedic procedures9,11,12,14,15,17. Coagulopathy is a rare complication of spinal arthrodesis; the reasons for its occurrence may be variable and may include activation of platelets and white blood cells4, consumption of clotting factors18, dilutional coagulopathy in association with massive transfusion20, and defibrination triggered by injury secondary to decortication or chipping at bone23.

We present here the case of a patient who had life-threatening disseminated intravascular coagulation. We believe that this complication was caused by a combination of factors, including dilutional coagulopathy in conjunction with intraoperative blood salvage and the use of absorbable gelatin sponges (Gelfoam; Upjohn, Kalamazoo, Michigan) soaked in topical thrombin (Thrombostat; Parke Davis, Morris Plains, New Jersey). Excessive hemodilution can precipitate the activation of platelets and . . . [Full Text of this Article]


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