deamino-arginine-vasopressin and Ecchymosis

The authors began to use 1-desamino-8-D-arginine vasopressin (DDAVP) Desmopressin Acetate routinely in their facelift patients who had a relatively high risk of bleeding, either from Von Willebrand factor deficiency, platelet dysfunction, aspirin intake, or ease of ecchymosis. Based on their observations that these patients had enhanced clotting and recovery times, they decided to undertake a prospective evaluation of the effects of Desmopressin Acetate when administered as a preoperative intravenous supplement during cosmetic facioplasty. A series of 200 consecutive patients undergoing surgery was divided into control and treatment groups. A total of 100 patients did not receive medication perioperatively, and 100 subsequent patients received preoperative DDAVP. All patients were observed for ecchymosis and swelling postoperatively and were graded by our postsurgical management team. Postsurgical ecchymosis was graded as mild (grade 1), moderate (grade 2), or severe (grade 3). Grade 4 indicated an expanding hematoma that required immediate surgical intervention. Grades 1 and 2 ecchymosis resolved within 3 weeks. Grade 3 ecchymosis or microhematomas required intervention such as needle aspiration or massage therapy. These small collections of blood generally required substantially longer to resolve and generated notable anxiety in the patients involved. Patients were excluded from the trial if there was a previous history of hypercoagulability or because treatment with DDAVP was medically contraindicated. A total of 23% of untreated patients required intervention for grade 3 ecchymosis compared with 3% of DDAVP-treated patients. No patients experienced any complications associated with DDAVP--namely, deep vein thrombosis, pulmonary embolus, electrolyte imbalance, or renal insufficiency. The authors undertook this study to determine whether DDAVP would help to decrease the incidence of microhematomas after facelift. Based on the results of their grading system and study, they think that the use of DDAVP is safe and efficacious in the prevention of troublesome microhematomas after facelift. Interestingly, although their male facelift patients challenged their efforts to obtain satisfactory hemostasis during and after surgery, the DDAVP-treated male patients responded with marked improvement in postoperative grading after treatment. Obtaining hemostasis intraoperatively was facilitated as well in these patients. This gender phenomenon was even more dramatic

Topics: Deamino Arginine Vasopressin; Ecchymosis; Female; Hematoma; Hemostatics; Humans; Male; Postoperative Complications; Prospective Studies; Rhytidoplasty

An acquired factor VIII inhibitor was found in an 82-year-old woman who presented with numerous spontaneously appearing ecchymoses. Coagulation studies revealed the presence of a prolonged activated partial thromboplastin time that was not corrected by 1:1 mixture with normal fresh plasma after a 2-h incubation. Factor VIII:C was 4%, and the titer for factor VIII inhibitor was 9 Bethesda units. Three months later, after a retroperitoneal hemorrhage, a lymphocytosis was found in her peripheral blood with morphological and surface immunophenotype characteristics of B-cell chronic lymphocytic leukemia, later confirmed by bone marrow morphological and immunocytochemical examinations. To our knowledge, this is the first report of an autoimmune factor VIII inhibitor associated with chronic lymphocytic leukemia.

Topics: Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Ecchymosis; Factor VIII; Female; Follow-Up Studies; Hemorrhage; Humans; Immunoglobulins, Intravenous; Immunophenotyping; Leukemia, Lymphocytic, Chronic, B-Cell; Partial Thromboplastin Time; Prednisone; Time Factors