26395443 Visualization

We report the case of a previously History healthy History 28 Age - year Age - old Age woman Sex , Afro Personal_background - Brazilian Personal_background , in her first History pregnancy History .
Our patient had no medical records until the 36th Date pregnancy Date week Date and reported allergy History to History diclofenac History .
She presented Clinical_event to our emergency Nonbiological_location department Nonbiological_location with an acute Detailed_description onset of abdominal Biological_structure pain Sign_symptom , jaundice Sign_symptom , nausea Sign_symptom and vomiting Sign_symptom , with no signs of encephalopathy Disease_disorder .
Her arterial Diagnostic_procedure blood Diagnostic_procedure pressure Diagnostic_procedure was 110/60mmHg Lab_value , heart Diagnostic_procedure rate Diagnostic_procedure was 98bpm Lab_value , axillary Diagnostic_procedure temperature Diagnostic_procedure was 35°C Lab_value , she was severely Severity dehydrated Sign_symptom and with decreased Lab_value peripheral Diagnostic_procedure perfusion Diagnostic_procedure .
The laboratory Diagnostic_procedure examinations Diagnostic_procedure revealed hemoglobin Diagnostic_procedure 12.3g/dL Lab_value , leukocytes Diagnostic_procedure 13 Lab_value   × Lab_value   109/mL Lab_value , platelets Diagnostic_procedure 97 Lab_value   × Lab_value   103/mm3 Lab_value , international Diagnostic_procedure nationalized Diagnostic_procedure ratio Diagnostic_procedure ( INR Diagnostic_procedure ) 6.9 Lab_value , fibrinogen Diagnostic_procedure 98mg/dL Lab_value , total Diagnostic_procedure bilirubin Diagnostic_procedure 14.2mg/dL Lab_value , serum Detailed_description creatinine Diagnostic_procedure 3.4mg/dL Lab_value , serum Detailed_description aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure ( AST Diagnostic_procedure ) 306U/L Lab_value , serum Detailed_description alanine Diagnostic_procedure aminotransferase Diagnostic_procedure ( ALP Diagnostic_procedure ) 302U/L Lab_value , arterial Diagnostic_procedure bicarbonate Diagnostic_procedure 11mEq/L Lab_value , arterial Diagnostic_procedure pH Diagnostic_procedure 7.21 Lab_value , blood Diagnostic_procedure glucose Diagnostic_procedure 65mg/dL Lab_value and ionic Diagnostic_procedure calcium Diagnostic_procedure 1.02mmol/L.
An abdominal Biological_structure ultrasound Diagnostic_procedure depicted fatty Sign_symptom infiltration Sign_symptom of the liver Biological_structure and confirmed Lab_value fetal Diagnostic_procedure viability Diagnostic_procedure .
Our patient received an initial fluid Medication load Medication with crystalloids Medication .
The calcium Diagnostic_procedure , glucose Diagnostic_procedure and hypothermia Disease_disorder were reversed Lab_value .
The diagnosis of AFLP Disease_disorder was confirmed following the Swansea’s Diagnostic_procedure criteria Diagnostic_procedure [9].
Therefore, a cesarean Therapeutic_procedure section Therapeutic_procedure was indicated.
A thromboelastometry Therapeutic_procedure ( ROTEM®, Detailed_description Pentapharm Detailed_description Co., Detailed_description Munich, Detailed_description Germany Detailed_description ) was performed at the beginning of the surgery Coreference .
The thromboelastometry Diagnostic_procedure analysis Diagnostic_procedure showed an intense Severity kinetic Detailed_description and structural Detailed_description hypocoagulable Sign_symptom state Sign_symptom (Fig.1 and Table 1).
The FIBTEM Diagnostic_procedure revealed an impairment Disease_disorder in Disease_disorder fibrinogen Disease_disorder function Disease_disorder quality Disease_disorder while the EXTEM Diagnostic_procedure depicted a coagulation Disease_disorder factor Disease_disorder deficiency Disease_disorder (Fig.1a-c and Table 1).
Based on, respectively, FIBTEM Diagnostic_procedure maximum Diagnostic_procedure clot Diagnostic_procedure firmness Diagnostic_procedure ( MCF Diagnostic_procedure ) ( 0mm Lab_value ; Table 1) and EXTEM Diagnostic_procedure clotting Diagnostic_procedure time Diagnostic_procedure ( CT Diagnostic_procedure ) ( 228s Lab_value ; Table 1), 4.0g Dosage of fibrinogen Medication concentrate Administration ( Haemocomplettan® Detailed_description P, Detailed_description CSL Detailed_description Behring, Detailed_description Marburg, Detailed_description Germany Detailed_description ) and 1000UI Dosage of prothrombin Medication complex Medication concentrate Administration ( Beriplex® Detailed_description P/N Detailed_description 500UI, Detailed_description CSL Detailed_description Behring, Detailed_description Marburg, Detailed_description Germany Detailed_description ) were administered at the beginning of the cesarean Therapeutic_procedure section Therapeutic_procedure .
The fluid Medication input Medication ( crystalloids Medication ) and output Diagnostic_procedure during the caesarian Therapeutic_procedure section Therapeutic_procedure were, respectively, 2000mL Dosage and 200mL.
The cesarean Therapeutic_procedure section Therapeutic_procedure succeeded Lab_value with no major Severity bleeding Sign_symptom after the hemostatic Therapeutic_procedure therapy Therapeutic_procedure .
Additional hemocomponent Medication transfusion Administration , such as fresh Medication frozen Medication plasma Medication ( FFP Medication ), cryoprecipitate Medication , platelets Medication or blood Medication concentrates Medication , was not necessary.
A second thromboelastometry Diagnostic_procedure analysis Diagnostic_procedure was performed at the end of surgery Coreference (Fig.1d-e and Table 1), showing a mild Severity hypocoagulation Sign_symptom state Sign_symptom .
The patient was admitted Clinical_event to the intensive Nonbiological_location care Nonbiological_location unit Nonbiological_location ( ICU Nonbiological_location ) and remained stable Sign_symptom , with no bleeding Sign_symptom during the recovery Therapeutic_procedure phase Therapeutic_procedure .
She was discharged Clinical_event from the ICU Nonbiological_location 3 Date days Date after Date admission Clinical_event and then 3 Date days Date later Date she was discharged Clinical_event from the hospital Nonbiological_location .