Findings and Hospital Course over the first 72 hours
- Transfusion of 3 units of RBCs increased the Hct to 25.6%.
- Direct and Indirect Coomb's both negative (done on original sample).
- LDH and total bilirubin did not increase further and subsequently declined to normal range.
- Mixing study completely corrects the prolonged PT and PTT.
- PT/PTT both normalized after 3 days of parenteral vitamin K. PT 11.9 sec (control 12.2 sec) PTT 26.2 sec
- Fibrin split products < 10, Fibrinogen remains > 600.
- Bleeding time 5.5 minutes.
- The abnormal coagulation tests can be explained by vitamin K deficiency.
- Doppler ultrasound negative for DVT/aneurysm/tumor.
- MRI shows no vascular abnormalities or unusual structures; the hematoma appeared to have started within the knee (intra-articular) and then extended into the soft tissue of the thigh.
4) GI symptoms and fever
- Nausea, vomiting, and abdominal pain were observed to be exacerbated by PO intake in the hospital.
- Abdominal CT revealed a distended gallbladder, dilated common bile duct, and fluid in the gallbladder fossa.
- GI consultation suggests chronic cholecystitis secondary to stone, tumor, stricture, or spasm from chronic morphine use. The fluid surrounding the gallbladder fossa could be from a resolving hematoma.
- ERCP confirms the CT findings of a diffusely-dilated biliary tree but fails to identify a cause.
- Laparoscopic cholecystectomy is successfully performed - culture of specimen is negative.
- Blood cultures and throat swabs show no bacterial pathogens.