G
Guest
Yesterday, I saw the most spectacular bruise that I have ever seen. The man is a 72-year old smoker who is on warfarin for atrial fibrillation. His INR was 2.7 at his last visit. He developed a pleural effusion (excessive fluid between the lung and the chest wall). This caused him to cough so hard that he was unable to eat for two days. When he woke up two days ago, he noted some tenderness in his abdomen. It got worse during the day and his son took him to the ER. They found an INR of 4.8 and hemorrhaging into the rectus abdominus muscles (the two muscles that run up and down along the sides of the belly). He was given 2 units of fresh frozen plasma (clotting factors that reverse warfarin faster than vitamin K). This brought his INR down to 2.4 but the bruising was getting worse. He was the color of eggplant from the bottom of his ribs too as far down as I wanted to pull the sheet with my female student along. His nurse said that it went almost to his knees and through his groin area and was up to his waist in back. His hemoglobin and hematocrit had dropped almost to critically low levels. He had gotten two units of packed red blood cells and was getting two more units of FFP. I asked him if he would mind if I showed some other students and he said, "It's OK". So I brought in 6 nursing students and their instructor and explained what had happened to them. Even the nursing instructor had never seen anything like this. He said that everybody who comes in says, "Wow" and asks if they can have someone else take a look. I haven't seen him yet today.
His blood levels dropped too, but he didn't need to get blood, so your guy wins. But he did have to stop Coumadin for a couple of days until the bleeding into the bruise stopped.