1 78-year-old woman with massive pulmonary embolism, obstructive shock, and profound anaemia (haemoglobin 4.5 g/dL) secondary to warm autoimmune haemolytic anaemia (AIHA).
Systemic thrombolysis with 100 mg recombinant tPA infused over two hours, along with packed red blood cell transfusion, intravenous hydrocortisone, and vasopressors.
Survival and resolution of pulmonary embolism
Thrombolysis can be safely administered for life-threatening massive pulmonary embolism even in the presence of profound anaemia secondary to autoimmune haemolytic anaemia, provided there is no active bleeding.
On arrival, her temperature was 36.5 C, blood pressure 90/50 mmHg, heart rate 108 bpm, respiratory rate 17 breaths/ min, and oxygen saturation 83% (room air).She was pale and icteric but without signs of active bleeding.Cardiopulmonary and abdominal examinations were unremarkable, and rectal examination revealed no blood.
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C.Y. Lau
Young Do Koh
Sameera Ganti
Eurasian Journal of Emergency Medicine
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Lau et al. (Mon,) studied this question.
www.synapsesocial.com/papers/69fd7cd4bfa21ec5bbf05b6e — DOI: https://doi.org/10.4274/eajem.galenos.2026.74507