A rare case of spontaneous hemoperitoneum in a bone marrow transplant recipient on VV-ECMO

Patrick Donabedian; Amir M Emtiazjoo; Mindaugus Rackauskas; Philip Efron; Cynthia Gries; Melissa Burger; Letitia Bible; Victoria Reams; Marc O Maybauer; Biplab K Saha

doi:10.1016/j.amjms.2024.08.017

A rare case of spontaneous hemoperitoneum in a bone marrow transplant recipient on VV-ECMO

Am J Med Sci. 2024 Aug 19:S0002-9629(24)01411-3. doi: 10.1016/j.amjms.2024.08.017. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
² Lung Transplant and ECMO Program, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.
³ Department of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
⁴ Department of Surgery and Critical Care, University of Florida, Gainesville, FL, USA.
⁵ Department of Anesthesiology and Critical Care, University of Florida, Gainesville, FL, USA.
⁶ Division of Pharmacy, University of Florida, Gainesville, FL, USA.
⁷ Lung Transplant and ECMO Program, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA. Electronic address: biplab.saha@medicine.ufl.edu.

PMID: 39168408
DOI: 10.1016/j.amjms.2024.08.017

Abstract

A 53-year-old man with acute myeloid leukemia received an allogeneic hematopoietic cell transplant (HCT) from a matched unrelated donor. One month after his transplantation, he developed ARDS requiring initiation of VV-ECMO. He suffered from pancytopenia, managed with frequent transfusions, granulocyte-colony stimulating factor (G-CSF) and weekly thrombopoietin receptor agonist. On ECMO day 17, the patient developed severe hypotension after insertion of a chest tube for a large right-sided pneumothorax. CT angiography of the abdomen showed hemoperitoneum. Exploratory laparotomy revealed approximately 4 L of blood and a ruptured splenic hilum. A splenectomy was performed. Unfortunately, the patient continued to require multiple daily blood products and his condition continued to decline despite two reoperations. His family chose to discontinue ECMO and he passed away peacefully. Spontaneous splenic rupture after GM-CSF has never been reported in patients on VV-ECMO. This manuscript reviews the literature regarding the pathophysiology and clinical manifestation of this rare occurrence.

Keywords: GM-CSF; Hemoperitoneum; Splenic rupture; Spontaneous; VV-ECMO.

Publication types

Review