Case Report: Refractory Life-Threatening Post-Biopsy Hemorrhage in a Neonate Successfully Controlled with Ankaferd Blood Stopper

Abstract

Introduction: Biopsy-related hemorrhage in neonates is rare but may rapidly become life-threatening when refractory to conventional hemostatic interventions. This case is unique in reporting the first successful use of topical Ankaferd Blood Stopper® (ABS) as a salvage hemostatic agent in a neonate with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas, an exceptionally rare malignancy, following life-threatening, refractory post-biopsy hemorrhage. Patient Concerns and Clinical Findings: A term female neonate presented with a rapidly enlarging left facial mass with proptosis and restricted eye movements. Intraoral incisional biopsy was performed to obtain histopathological diagnosis. Within 72–74 hours post-biopsy, active hemorrhage persisted despite multiple conventional hemostatic measures, including local compression, topical epinephrine, intravenous tranexamic acid, vitamin K, and fresh frozen plasma (FFP). The neonate developed hemorrhagic shock with hemodynamic instability (heart rate >170 bpm, blood pressure 45/25 mmHg, oxygen saturation <88%) and required packed red blood cell (PRBC) transfusion. Baseline coagulation parameters were within normal neonatal reference ranges; comprehensive coagulopathy screening excluded an underlying bleeding disorder. Diagnosis, Intervention, and Outcomes: Histopathological examination was most consistent with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas. Topical ABS was applied as a salvage intervention at 72–74 hours post-biopsy. Hemostasis was achieved within minutes and was reproducible across three applications, with a total administered volume of no more than 6 mL and no local or systemic adverse effects. The neonate subsequently underwent urgent surgical debulking/resection and adjuvant therapy. At six-month follow-up, the patient remains alive without evidence of disease recurrence. Conclusion: Topical ABS may represent an effective and potentially lifesaving option for managing severe, refractory hemorrhage in neonates when conventional therapies fail. Its coagulation-independent mechanism may be particularly advantageous in this vulnerable population. This case highlights the importance of considering ABS in life-threatening neonatal hemorrhagic emergencies and underscores the need for prospective studies to establish standardized neonatal protocols.