A patient with 16 liter blood loss during radical prostatectomy

Radical prostatectomy is the treatment of choice for localized prostate neoplasm. Bleeding is a common problem during this operation. Massive bleeding can occur in case of injury of one of the hypogastric vein branches during lymphadenectomy or transection of the dorsal vein plexus. We present a 67-year-old patient that lost 16 liters of blood during the operation. In order to restitute the lost blood volume and prevent the low cardiac output and hypoxia, the patient was administered crystalloids, colloids, blood and blood derivatives. The patient received epinephrine, norepinephrine and dopamine to maintain mean arterial pressure above 55 mm Hg. After stopping surgical bleeding, stabilization of the coagulation system was achieved and further nonsurgical bleeding prevented by aprotinin and recombinant factor VIla. Timely volume restitution, not only with blood and blood components, was crucial to prevent the consequences of hemorrhagic shock. With pharmacological interventions, by aprotinin and recombinant factor VIIa in particular, we can act prophylactically and therapeutically to stop nonsurgical bleeding. Multimodal therapeutic procedures, promptly administered in massive bleeding, can improve the survival prognosis.