Re: Alcoholic with DUB
From: Rupak Ranjan Roy (rupakray@caltiger.com)
Wed Jun 21 21:15:48 2000
Fibrinogen?
--
Rupak Ranjan Roy
MRCOG
>----- Original Message -----
From: Geffrey Klein, MD <gklein@icsi.net>
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net>
Sent: 22 June 2000 12:23
Subject: Re: Alcoholic with DUB
> At 12:21 PM -0500 on 6/21/00, ainsron@msn.com wrote:
>
> >I saw an interesting patient in the ER yesterday with a problem I've
> >never seen before. She is a known alcoholic, C/O heavy vaginal bleeding
> >with clots for six weeks. 2wks before she was seen in the ER, examined
> >by a PA and placed on Provera 10mg BID for the working Dx of
> >annovulatory DUB; I'd seen her for a similar problem several years ago.
> >She was scheduled to see me in two weeks but because the bleeding wasn't
> >controlled, she returned to the ER. On exam this time, the ER doc
> >didn't see any bleeding from the cervix, it was coming from the
> >posterior vaginal wall and ultrasound showed no endometrial thickening,
> >polyp, etc. She denies any intercourse since the bleeding started or
> >instrumentation of the vagina, but had been using tampons. When I
> >examined her she had two large desquamated areas on the anterior and
> >posterior walls with active bleeding from the posterior wall. It was
> >not indurated or otherwise abnormal in appearance. I took her to the
> >OR, biopsied the areas (bled like hell when I biopsed them, several
> >small pumpers) and oversewed them and packed the vagina overnite, which
> >controlled the bleeding. Her preop labs showed abnormal LFTs, mild
> >hyperbilirubinemia, neutropenia, thrombocytopenia (49,000), normal PT,
> >PTT and INR. She had several large bruises and bleeding time was over
> >30 minutes. My working diagnosis is bleeding disorder secondary to
> >hyperspleenism. Anyone ever seen anything similar? Does portal
> >hypertension cause problems with vaginal varices, like it does at the
> >esophagus? No bleeding when I took the pack out, but she also ended up
> >in the ICU in DTs this AM.
> >
> >--
> >Ronald E. Ainsworth, MD
>
> What was her PT/PTT? Alcoholics with liver disease can have an
> aquired coagulopathy..
>
> --
> _______________________
> Geffrey H. Klein, MD
> _______________________
> geffrey.klein@obgyn.net
> 200 Medical Center Blvd Suite 103
> Webster, TX 77598
> (281) 332 6723
>
> http://www.geffreyklein.com
>
