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94
Correspondence
Anterior epidural haematomafollowing A crucial role in spinal bleeding might be attributed to the
subarachnoid block use of subcutaneous heparin 1.zbut other factors in this patient
may have conlributed and spontaneous bleeding is not exclud-
ed. An increase of portal pressure, which may occur with
To the Editor: hepatic dysfuntion, may divert blood into epidural veins,
We have observed an epidural haematoma (El-I) in a 64-yr-old which become dilated and prone to bleeding.3 Although the
female patient admitted for a fight-knee fracture. At admission platelet count was within the normal range, we do not know
she was not receiving any medication. There was a remote his- how well those platelets were functioning and what effect liver
tory, 17 yr earlier of possible primary biliary cirrhosis. The disease might have on platelet function. Finally, the associa-
only abnormal tests were the serum alkaline phosphatase tion between heparin and NSAID.s is considered as a risk fac-
(ALP) (407 U . L -I) and serum gamma-glutamyl transpepti- tor of bleeding following central neuraxial blockade.4
dase (GGT) (168 U.L-~). Prophylaxis against deep venous
thrombosis was undertaken with 5000 U calcium heparinate sc F. Bartoli MD
every eight hours. Coagulation status, monitored at the time of R. Barbagli MD
surgery, showed platelet count 128.000. ml-j, fibrinogen 397 F. Rucci PhD
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