PMC10455857_01
Examination and clinical course during the initial admission. (a) Computed tomography image of the pelvic region showing a large blood clot in the bladder. (b) Cystoscopy revealed numerous easily hemorrhagic dilated vessels, which can be mainly observed in the neck of the bladder. (c) Clinical course during the initial admission. The hematuria disappeared once the serum hemoglobin levels increased with blood transfusion. Thereafter, no recurrence of hematuria was observed after transfusion, and the patient was discharged on the seventh day of hospitalization.
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Computed tomography (CT) showed large blood clots in the bladder (Figure 1a). Cystoscopy revealed dilated hemorrhagic vessels, mainly in the bladder neck (Figure 1b). TUC for hemostasis management, it was not performed because the serum hemoglobin level improved to 10.0 g/dL after the transfusion, and the hematuria resolved spontaneously. Thereafter, hematuria did not recur, and the patient was discharged on day 7 (Figure 1c).
Course of serum hemoglobin levels during the period between discharge and hospitalization (between the third discharge and fourth hospitalization). The serum hemoglobin level, which was elevated at discharge, started to decline slowly without macrohematuria. At a low hemoglobin level, the hematuria suddenly appeared and resulted in bladder tamponade.
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When the serum hemoglobin level dropped below the physiological range, bladder tamponade suddenly appeared every time (Figure 2).
Long-term course of serum hemoglobin levels in the patient. When the serum hemoglobin level was low (especially below 9 g/dL), bladder tamponade was more likely to recur. Once treatment for chronic anemia was initiated to prevent a decline in serum hemoglobin levels, bladder tamponade did not recur.
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In addition, based on the clinical course, it was suggested that the risk of developing bladder tamponade increased when the serum hemoglobin level was below 9.0 g/dL (Figure 3). APTT, remained stable regardless of serum hemoglobin level (Figure 4). As a result, the patient has not had a single recurrence of bladder tamponade, which had previously been frequent, in more than 27 months since then (Figure 3).
Long-term course of complete blood count and coagulation profile in the patient. (a) Long-term course of complete blood count in the patient. When bladder tamponade occurred, changes in white blood cell (WBC) and platelet (PLT) counts occurred. However, these changes had little effect on hemostatic capacity and were very unlikely to predispose to hematuria. (b) Long-term course of coagulation profile in the patient. Prothrombin time-international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT) were within normal limits each time.
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APTT, remained stable regardless of serum hemoglobin level (Figure 4). As a result, the patient has not had a single recurrence of bladder tamponade, which had previously been frequent, in more than 27 months since then (Figure 3).