Pune (Voice News Service):A 23-year-old young women fought the battle of her life when unprecedented bleeding led her to the emergency room of Ruby Hall Clinic. A patient of Gilbert’s syndrome (a genetic liver condition leading to an imbalance of bilirubin levels), she suffered from a liver decomposation. She went into shock while being rushed to the hospital in the early hours of the morning.
Liver diseases, such as cirrhosis, can increase the blood pressure inside the vessels that connect the hepatic and portal veins. This increase in blood pressure may lead to a serious condition called portal hypertension. “The patient was profusely bleeding internally when she was brought to us. It was priority for us to determine the source of bleeding which in itself was a challenge. In fact, her bleeding was so severe that an endoscopy was not possible. A CT angio showed what is known as variceal bleeding,” explained Dr. Prachee Sathe, Director – ICU, Ruby Hall Clinic. Varices are abnormal, enlarged veins in the stomach that can leak blood or even rupture, causing life-threatening bleeding.
“The patient was unstable and her haemoglobin had dropped to 2.8.Her pulse was significantly down. We immediately got to work and started a massive transfusion protocol to help stabilise her. The only option we seemed to have was to reduce the portal pressure so that the varices would stop bleeding,” added Dr. Vijay Ramanan, Sr. Consultant Clinical Haematologist. Director, Clinical Hematology, Bone Marrow and Stem Cell Transplant, Ruby Hall Clinic. Doctors use a special minimally invasive procedure known as TIPS (transjugular intrahepatic portosystemic shunt) to relieve blood pressure in the portal vein by rerouting the blood flow from the other digestive organs past the liver.
Massive transfusion protocol requires very strict protocols to be followed in the institution to make available O negative 4 Packed red blood cells (PCVs) , 4 Fresh Frozen Plasma (FFP ), and any group 4 random or 1 single donor platelet to be made available within minutes. The blood bank under the leadership of Dr Snehal Mujumdar has taken this responsibility which has proven life saving in situations like this. In such situations apart from IV fluids there is an urgent need to blood components which was possible because of our state-of-the-art Blood Bank. This proves to be lifesaving in such emergency cases.
“Very few doctors in India attempt the TIPS procedure considering the severity of the patient’s condition. But our team was willing to take that risk in order to save her life. We connected the hepatic vein to the portal vein while bypassing the liver and using a stent. This was done with a 2mm pinhole in her neck. Through the portal vein we could also go into the varices where we put in coils and glue to block them. This stopped her bleeding immediately and her vitals were stable in the next 24 hours, ventilator was removed and within 2 to 3 days she was out of the ICU ” concluded Dr. Sathe. She is now stable.
The multidisciplinary team of specialists included speclialists from ICU department including Dr .Prachee Sathe , Intensivist Dr. Sanmay Chaudhary, Dr. Tanima Baronia , Interventional Radiologist Dr. Yadav Munde, Director of Blood Bank at RHC Dr. Snehal Mujumdar, Haematologist Dr. Vijay Ramanan, Gastroenterologist Dr. Nitin Pai , Dr. Sahil Rasne, Dr. Auti, Dr. Durgesh Makwana and Dr. Sharad Yadav.
Explained Dr. Manisha Karmarkar, COO, Ruby Hall Clinic, “Rare and challenging cases such as these reinstate our belief in multidisciplinary care. I commend all the teams involved for taking crucial calls that saved the patient’s life. We at Ruby Hall Clinic take pride in providing specialised intensive care in even the most complex cases. It’s what we’ve done through the years and will continue to do so in the time to come.”
