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July 25, 1977

Vasovagal Pseudohemorrhage

Author Affiliations

University of Rochester School of Medicine and Dentistry Rochester, NY

JAMA. 1977;238(4):304. doi:10.1001/jama.1977.03280040024004

To the Editor.—  It comes as a surprise to find as the title for an article such a curiosity as, "Vasovagal Pseudohemorrhage: Complication of Percutaneous Renal Biopsy" (23:1359-1360, 1977). Careful reading of the case protocol by Bolton et al suggests this to have been an instance of a prolonged vasopressor syncopal reaction, as occasionally occurs during minor injury or threat of injury, especially among subjects fearful of the experience. We have reported subjects who have remained syncopal, with bradycardia and postural blood pressure falling for more than two hours, in response to as trivial a threat as a venipuncture; recovery took place promptly on withdrawal of the threat.1 Percutaneous renal and hepatic biopsy, indeed any invasive diagnostic procedure, provide almost paradigmatic conditions for the precipation of vasodepressor reactions in psychologically vulnerable subjects, reactions that may be prolonged in response to the alarmed (and alarming) behavior of the staff. These