HEMOSTATIC EFFICACY OF ANKAFERD BLOOD STOPPER IN ARTERIOVENOUS MALFORMATION WITHIN CERVICAL MYOMA YAPAR EYI EG, OZKAN MS ; HAZNEDAROGLU IC Zekai Tahir Burak Women Health Education & Research Center Ankara-Turkey AIM: Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system This vascular anomaly, widely known because of its occurrence in the central nervous system, may rarely arise in the uterus, in complex capillary networks within cervical myoma. . Although most of the AV malformations are small, uterine AVM may be potentially lethal due to massive hemorrhage and is generally associated with uterine trauma, such as dilatation and curettage, therapeutic abortion or uterine surgery.. We report herein a patient with uterine AVM formed within a 5cm cervical myoma. in whom the AVM visualized sonographically during carman aspiration of a 7week ebryonic demise after profuse hemorrhage and treated with a new hemostatic agent. METHODS: The Ankaferd Blood Stopper®(ABS) is a new hemostatic agent licensed for external hemorrhages in Turkey. It is a standardized mixture of five plants; Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum and Urtica dioica. This agent has a dominant and imminent hemostatic effect by vital erytoid aggregation. In contracted clots and thrombi, erythrocytes are compressed to close packed polyhedral structures with platelets and fibrin on the surface. Polyhedrocytes form an impermeable seal to stem bleeding and help prevent vascular obstruction but confer resistance to fibrinolysis(Figure 1). Embryonic demise was diagnosed in a 32 year old pregnant woman at 7 weeks gestation with a previous casearean delivery. There were right sided cervical 5 cm intramural myoma and 3.5 cm cervical left sided myomas . Elevation of the gestational sac and distortion on the endometrial cavity were visualized sonographically. The patient underwent carman aspiration under analgesia and anesthesia; however profuse hemorrhage complicated the procedure. Meantime, collection of blood was seen in the capsule of the right sided myoma(Figure 2). Vascular pattern of AV malformation was visualized.(Figure 3) There was acute and dramatic fall in hemoglobin(3gram/dL) and hematocrit levels(10%) together with moderate hypotension and tachycardia. As bleeding in pulsatile pattern was continuing, 4 ml ABS was applied from the cervical os to stop bleeding . a Figure 1: Hemostatic network induced by Ankaferd b Figure 2a-b: Cervical myomas Figure 3: Color flow Doppler in cervical myoma RESULTS: 4ml ABS solution controlled profuse hemorrhage from AVM within right sided intramural 5 cm myoma near the internal cervical os occurred during evacuation of a 7 week embryonic death. CONCLUSION: External application of ABS solution may have a role in the treatment of AVM originating from the uterine cervical myomas. REFERENCES 1. Demiralp D. Haznedaroğlu IC, Akar N; Functional Proteomic Analysis Of Ankaferd® Blood Stopper; Turk J Hematol; 2010; 27:70-7 2. Haznedaroglu, BZ; Beyazit, Y; Walker, SL; Haznedaroglu, IC; Pleiotropic Cellular, Hemostatic, and Biological Actions of Ankaferd Hemostat; Critical Reviews in Oncology Hematology; 2012; 83(1): 21-34 Doi: 10.1016/j.critrevonc.2011.10.006