Viscoelastic Testing and Factor Concentrate Therapy to Reduce Bleeding and Transfusions in the Surgical Separation of Ischiophagus Twins: A Case Report.

TitleViscoelastic Testing and Factor Concentrate Therapy to Reduce Bleeding and Transfusions in the Surgical Separation of Ischiophagus Twins: A Case Report.
Publication TypeJournal Article
Year of Publication2022
AuthorsSarmiento IA, Brenner AC, Haas T, Cushing MM
Corporate AuthorsContributors
JournalA A Pract
Volume16
Issue6
Paginatione01594
Date Published2022 Jun 01
ISSN2575-3126
KeywordsBlood Transfusion, Child, Hemorrhage, Humans, Twins, Conjoined
Abstract

The surgical procedure to separate conjoined twins represents a rare and major challenge. One of the most feared perioperative scenarios is the presence of coagulopathy secondary to bleeding. We present a case of the surgical separation of ischiopagus tetrapus twins using a patient blood management strategy encompassing a tranexamic acid infusion, intraoperative viscoelastic testing, and early fibrinogen supplementation to reduce bleeding and transfusions. This approach allowed early detection and treatment of acquired hypofibrinogenemia, which resulted in minimal exposure to blood products. This case reflects the increasing clinical interest in early avoidance of fibrinogen deficiency in complex noncardiac pediatric surgery.

DOI10.1213/XAA.0000000000001594
Alternate JournalA A Pract
PubMed ID35732023
Related Faculty: 
Melissa Cushing, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700