High-sensitivity to heparin associates with cell salvage transfusion in adolescent idiopathic scoliosis patient undergoing posterior spinal fusion.

A 16-year-old male with adolescent idiopathic scoliosis was scheduled for the posterior spinal fusion (PSF) under general anesthesia. The cell saver was routinely prepared preoperatively and 400 ml of salvaged red blood cells were transfused during the surgery. After the cell salvage transfusion, the oozing of blood in surgical wounds occurred and the activated coagulation time (ACT) of the arterial blood was 999 s, considering the possibility of the residual heparin in the cell salvage, 30 mg of protamine was injected intravenously, 5 min later the ACT dropped to 125 s. After the therapy, the surgical procedure was performed successfully. After the procedure was over, the patient went back to the ward with normal coagulation function indicators. 11 days later, the patient was discharged home without complications. We present this case of coagulopathy caused by minor cell salvage transfusion and wish to highlight the importance of the blood coagulation monitoring that can be overlooked in these situations.