Key Points
COVID-19 increases venous thromboembolism (VTE) risk.
Enhanced low-molecular weight heparin (LMWH) regime required in COVID-19.
Increased spontaneous internal bleed.
Imaging to exclude internal bleed.
Individualise treatment in older people.
An 89-year-old female patient dropped her haemoglobin by over 40 g/l, and hence required blood transfusion whilst being treated for COVID-19 pneumonia. She had no external bleeding and physical examination was unremarkable. Computed tomography imaging revealed that she had a large right-sided psoas haematoma (Figure 1). Sadly, the patient died despite active treatment.
Figure 1 .
Psoas haematoma.
All adult patients are required to be assessed for venous thromboembolism (VTE) prophylaxis (NG 89). This patient received an enhanced regime of low-molecular weight heparin (LMWH) as per NICE guidelines (NG 186) due to the increased risk of VTE in COVID-19. [1] Unilateral spontaneous psoas haematomas have previously been described in the use of the standard prophylactic dose of LMWH. [2] These often present with non-specific symptoms, and hence, diagnosis can be difficult. [3]
Older patients, often with multiple co-morbidities require tailored treatment plans in the prevention of VTE in COVID-19 due to the risk of internal bleeding. Patients with a fall in haemoglobin and no clinical findings may benefit from radiological investigation to exclude spontaneous internal haemorrhage.
Contributor Information
Abhay Kumar Das, Department of Elderly Medicine, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
Toby Price, Department of Elderly Medicine, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
Joshua Woodcock-Shaw, Department of Elderly Medicine, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
Ngoni Khomisani Zava, Department of Elderly Medicine, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
Declaration of Conflicts of Interest
None.
Declaration of Sources of Funding
None.
Declaration of Consent
Written informed consent for publication of their clinical details and clinical images was obtained from the proxy.
References
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