Prolonged remission after life-threatening gastrointestinal hemorrhage from coexistent angiodysplasia and acquired bleeding diathesis.
A patient with angiodysplasia of the stomach and duodenum developed exceptionally severe and protracted gastrointestinal hemorrhage. Bleeding was intensified by a coexistent acquired hemostatic disorder characterized by decreased platelet aggregation with adenosine diphosphate, collagen, epinephrine and ristocetin, and a decrease in both plasma ristocetin cofactor activity and high-molecular-weight von Willebrand factor multimers. Cryoprecipitate infusion corrected the von Willebrand factor defect but did not improve platelet aggregation. Bleeding stopped after prolonged aggressive combined medical and surgical therapy, and the patient had no recurrence of bleeding while followed for 27 months. Hemorrhage from the vascular lesions themselves dominated the clinical picture of this patient and other reported patients with coexistent angiodysplasia and congenital or acquired hemostatic abnormalities.
Woodlock
T J
TJ
Department of Medicine, University of Rochester School of Medicine and Dentistry, New York 14642.
Francis
C W
CW
Rowe
J M
JM
Brown
M J
MJ
Marder
V J
VJ
D000368:Aged; D001165:Arteriovenous Malformations / Q000097:blood / Q000150:complications*; D001780:Blood Coagulation Tests; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology*; D006474:Hemorrhagic Disorders / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D012074:Remission Induction