On a OHSS severe case with serous hemorragic widpread fluids
History of present illness:
It must be noted that the haematic fluids showed an HT higher than the venous blood, due to the evident reabsorption of some of the liquid phase, proving the seious damage caused by the vascular endothelial growth factor (VEGF) a typical factor of this pathology.
The patient, affected by Iperandrogenism (Plasamtic testosterone: 6,63 nmol/L) with a secondary hypertricosis and amenorrea and by a mediterranean anaemia in base form had already been treated 6 years preciously with a pharmacological ovaric hyperstimulation with clomifene with a positive outcome.
In conformity with the most recent international litterature about Syndrome by Infiammatory Sistemic Response (SRIS), protection of the vasal endothelial and about thrombo embolic complications, and without EBM specific treatments, we had subjected the patient to a therapy with Antithrombin III in changeable dosages between 2000 and 8000 units pro die, based on the monitoring D.Dimer P.T. P.T.T. Fybrinogen and AT parameters.
Any eparine preparation or activated Protein C (APC) have been gived.
Obviously homologus haematic transfusions have been widely used.
Continuous abdominal ultrasound demonstrated the progressive reduction of the ovaries, which presented a maximum 15 cm diameter during the critical stage of this pathology.
All others investigationes had never showed hemorrhages in other sites.
The complete restitutio ad integrum has been reached in about 37 days since the dyagnosis.
The sostitutive therapy with AT has been reduced step by step, reaching the complete suspension in relation to the increase of endogen production, confirming the prognostic value of progressive growth of the AT levels.
A recent clinic control has attested the complete recovery.
This case appear to be a confirmation of the utility of a sostitutive therapy with concentrated of AT III.
Its possible that, during pregnancy with OHSS risk, analises that demonstrate a physiological lowering of the AT III levels may anticipate the onset of the syndrome.
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