UNPROVOKED PULMONARY EMBOLISM IN A RENAL TRANSPLANT PATIENT WITH BETA THALASSAEMIA MAJOR

C MCGOWAN1, T HAN1, C HAN1, Z THET

1Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland.

Background: A range of laboratory tests has provided solid evidence for the existence of a chronic hypercoagulable state in thalassemia, but thromboembolic complications in thalassaemia has not been emphasized or comprehensively reviewed. In most cases of venous thromboembolic events (VTE), thrombosis was spontaneous and there were no known risk factors. VTE is more prevalent in patients who are not receiving regular transfusions and who have undergone splenectomy. Current limited evidence recommends regular blood transfusions aiming to keep haemoglobin > 90g/L in an effort to reduce VTE.

Case Report: A 56 year old Asian, renal transplant patient presented to the Emergency Department with sudden onset, pleuritic chest pain associated with shortness of breath, on a background history beta thalassaemia major. The patient’s haemoglobin was approximately 80 g/L despite twice monthly blood transfusions and maximum dose erythropoietin therapy. On examination she was found to have splenomegaly but no other significant findings. Subsequent investigations concluded unprovoked multiple, bilateral, large pulmonary thromboemboli. She was commenced on anticoagulation and discharged home on warfarin. This case triggered a literature review which revealed evidence of hypercoagulability in patients with thalassaemia.

Conclusions: Thalassemia patients who have developed an acute thrombotic event should be considered for prolonged antithrombotic therapy, in view of thalassemia associated hypercoagulable state. In a renal transplant patient, frequent blood transfusions aiming for haemoglobin > 90g/L may not be advisable, in light of an increased risk of graft rejection as a result. Further studies are required to gain better insight into treatment and prevention of VTE, in renal transplant patients with thalassaemia.

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The ASM is hosted by Australian and New Zealand Society of Nephrology.

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