Surgical Bleeding

Lisa Arfons, MD and Alvin Schmaier, MD

Case Western Reserve University, Cleveland, OH

Copyright of the American Society of Hematology, 2011. ISSN: 1931-6860.


The present patient had DIC as result of surgical removal of a massive thrombus in her pulmonary artery. The DIC can be due to various etiologies. First, in order to perform the embolectomy, the patient required a circulatory arrest operation for 45 minutes. Under the no-flow conditions, there can be tissue destruction with DIC upon reperfusion. This effect on tissue is magnified in this operation, which requires that the patient’s core temperature be chilled to 19oC in order not to negatively influence brain function from the circulatory arrest. Second, cardiovascular surgeons often use blood loss savers by re-infusing blood lost in the operative field back into the patient. This material can have activated coagulation proteins contributing to a DIC. Third, there may be a unique feature about surgery on the thrombus that could also contribute to the blood coagulation state.

Have a question or comment about the ASH Teaching Cases? Please e-mail