Anaemia in a patient with rheumatoid arthritis recovering from revision of a hip replacement

A. Prabu, J. Bhosle, M. J. Duddy, A. M. C. Thomas and E. C. C. Rankin

University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, UK

Correspondence to: E. Rankin, Rheumatology, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham B29 6JD, UK. E-mail: elizabeth.rankin{at}uhb.nhs.uk

SIR, A 69-yr-old woman with rheumatoid arthritis since 1970 was admitted in 2001 with right hip pain. She had had a right total hip replacement (THR) in 1976 requiring two revisions. She had further revision of the right THR in 2002. Pre-operative angiography was normal. Post-operatively, she again developed pain, tenderness and swelling in the right hip. Radiographs were unremarkable. Her haemoglobin (Hb) fell from 10.7 to 8.3 g/dl. Ultrasound examination of the right hip revealed a large hypo-echoic area, representing a haematoma. The Hb fell despite blood transfusions. A digital subtraction angiogram (DSA) of the right femoral vessels revealed a large pseudo-aneurysmal sac (Fig. 1) fed by the perforating branch of the profunda femoris artery. The pseudo-aneurysm was treated with a fibred coil embolization procedure (Fig. 2). Post-procedure, her Hb remained steady, and pain and swelling resolved.


Figure 1
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FIG. 1. DSA shows a jet of contrast (arrow) into the large sac of a pseudo-aneurysm from the perforating branch of the right profunda femoris artery.

 

Figure 2
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FIG. 2. DSA following coil embolization (arrow) using three VortX-35 fibred platinum coils (Target Vascular/Boston Scientific) shows good control with no filling of the sac.

 
This case illustrates an unusual cause of post-operative anaemia following revision of THR. A false aneurysm occurs when a small laceration in the wall of a large artery allows blood to leak into the tissues. Appearances are those of a haematoma on grey-scale ultrasound imaging. Colour Doppler insonation should demonstrate flow within a hypo-echoic sac.

We are grateful to the patient, who gave written consent for us to describe her case, and to Dr Jubb, consultant rheumatologist, for his permission to describe this case.

The authors have declared no conflicts of interest.

Accepted 30 June 2005





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