During the summer, a middle-aged man and an elderly man were diagnosed with
heat stroke,
rhabdomyolysis, and acute renal impairment. Low-dose
enoxaparin sodium was initiated for prophylaxis of
deep vein thrombosis after the disease was stabilized with
continuous renal replacement therapy. After that, the patients'
hemoglobin decreased progressively, and no obvious intracranial, thoracic, digestive, or skin
bleeding tendency was found. However, one of the patients had hip
muscle pain, and computed tomography and color ultrasound confirmed that the patients separately had lumbar back and hip intermuscular
hematoma. After discontinuation of
anticoagulant drugs and monitoring of the steady increase in
hemoglobin, the intermuscular
hematomas were gradually absorbed. Following the use of prophylactic anticoagulation
therapy, the patients'
hemoglobin showed a progressive downward trend.
Hematoma formation in the lumbosacral and buttock muscles was confirmed after excluding
bleeding in typical regions (such as the digestive tract, thoracic cavity, and abdominal cavity).
Anticoagulant drugs were discontinued immediately, and
nutritional support was increased. Subsequently, the
hemoglobin levels gradually increased, and the
hematoma volumes gradually decreased.
CONCLUSION: Patients with
rhabdomyolysis have a risk of muscle
bleeding, and inappropriate use of
anticoagulants may lead to an increased risk or even to the formation of an intermuscular
hematoma. When continuous blood loss is found in the body, the possibility of
bleeding in the muscles and more typical sites should be considered.