Multiple retroperitoneal hemorrhage in a hemodialysis patient - A case report

Uremic patients on maintenance hemodialysis (HD) therapy have bleeding tendency, but spontaneous retroperitoneal bleeding is rare. We hereby reported a chronic HD patient who developed spontaneous retroperitoneal hemorrhage for three times. He had diabetic nephropathy in end-stage and received chronic HD for more than eight years. Two episodes of retroperitoneal hemorrhage occurred about one and half years and one year ago. Normal renal arteriogram was found. Then, he was treated with low molecular weight heparin (Fraxiparin) during HD therapy. He developed right lower abdominal pain and with spontaneous improvement. But severe right lower back pain attacked two weeks later and he was sent to our ER. Enhanced computed tomography of abdomen revealed right peri-renal hematoma (8.1 × 8.0 cm²). He received supportive therapy with packed RBC 8 u, DDAVP 20 mg IV q8h for 1 day, morphin 5 mg, bed rest, and heparin-free HD therapy. He was discharged smoothly 10 days later. We considered that unfractioned heparin or low molecular weight heparin may be contributory to his repeated bleeding.