Medicinal leech therapy is a form of complementary medicine that has long been practised and is gaining popularity in recent years for various illnesses and surgical applications. However, leech saliva contains proteins with anticoagulant properties that can lead to prolonged bleeding from the bite area. We report a case of a 35-year-old male who presented to the Emergency Department due to prolonged bleeding from a leech-bite wound. He did not have any significant past medical history or medication history. He had undergone medicinal leech therapy for chronic back pain. After the therapy, he noted that the bleeding did not stop after 7 hours (which normally stops within 30 minutes) and decided to seek treatment. There were wounds over his lower back and both feet, which were all clean. The wound over the lower back had persistent oozing. We applied topical adrenaline and manual compression on the wound, and eventually the bleeding reduced and stopped. There are many suggested methods to stop bleeding from leech-bite wounds but there is scarcity of evidence regarding the superiority of any method. This is the first case report regarding bleeding complications in medicinal leech therapy in Malaysia. This report aims to raise awareness regarding the complications arising from a leech bite among the practitioners of medicinal leech therapy, the public and healthcare providers in emergency facilities. We also suggest using topical adrenaline as an alternative to help stop bleeding from leech-bite wounds.
Prolonged Bleeding due to Hirudotherapy (Medicinal Leech Therapy)
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Abstrak
Terapi lintah adalah sejenis perubatan traditional yang telah lama diamalkan dan semakin popular sejak kebelakangan ini untuk pelbagai penyakit dan aplikasi pembedahan. Walau bagaimanapun, air liur dari lintah mengandungi protein dengan sifat antikoagulan yang boleh mengakibatkan pendarahan yang berpanjangan di kawasan gigitan. Kami melaporkan kes seorang lelaki berusia 35 tahun yang datang ke Jabatan Kecemasan kerana pendarahan yang berlarutan daripada kesan luka gigitan lintah. Beliau tidak mempunyai sejarah perubatan atau pengambilan ubatan yang lain. Beliau menjalani terapi lintah untuk merawat sakit belakang kronik. Selepas terapi, beliau menyatakan bahawa pendarahan tidak berhenti selepas 7 jam dan memutuskan untuk mendapatkan rawatan di hospital. Terdapat luka di bahagian belakang dan kedua-dua kakinya. Semua lukanya bersih tetapi luka di belakang masih berdarah. Ubat adrenalin digunakan sambil memberi mampatan atas luka dan akhirnya pendarahan semakin berkurang dan berhenti. Terdapat banyak kaedah yang dicadangkan untuk menghentikan pendarahan tetapi tiada bukti mengenai kelebihan mana-mana kaedah. Ini adalah laporan kes pertama mengenai komplikasi terapi lintah di Malaysia. Laporan kes ini adalah untuk meningkatkan kesedaran di kalangan pengamal terapi lintah, staf bahagian perubatan kecemasan dan orang awam mengenai komplikasi dari gigitan lintah. Kami juga mencadangkan penggunaan adrenalin topikal sebagai alternatif untuk membantu menghentikan pendarahan daripada luka gigitan lintah.
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