Long-lasting intestinal bleeding in an old patient with multiple mucosal vascular abnormalities and Glanzmann's thrombasthenia: 3-year pharmacological management.
A 75-year-old woman with Glanzmann's thrombasthenia was admitted because of persistent melaena. Endoscopic examination showed multiple angiodysplastic lesions, with active bleeding in small and large bowel. Electro-coagulation of some lesions, octreotide, conjugated oestrogens and selective embolization of jejunal vessels did not change transfusion requirements. After 8 month-transfusions, ethinylestradiol + norethisterone in association with octreotide was started, leading to no transfusion over the following 9 months. Bleeding recurred after withdrawing octreotide and substituting ethinylestradiol + norgestrel for the ethinylestradiol + norethisterone combination. Re-introduction of octreotide did not improve bleeding; however, a reduction of transfusion requirement was observed when the ethinylestradiol + norethisterone pill was re-administered. The association of octreotide and of an oestrogen-progesterone combination was helpful in the difficult management of recurrent bleeding in this patient with diffuse gastrointestinal vascular abnormalities and a severe condition predisposing to bleeding.
Coppola
A
A
Centro di Coordinamento Regionale per le Emocoagulopatie, Cattedra di Gastroenterologia, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Napoli, Italy. antocopp@unina.it
De Stefano
V
V
Tufano
A
A
Nardone
G
G
Amoriello
A
A
Cerbone
A M
AM
Di Minno
G
G
D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy; D016888:Angiodysplasia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001803:Blood Transfusion; D004359:Drug Therapy, Combination; D004564:Electrocoagulation; D045166:Estradiol Congeners / Q000008:administration & dosage; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000628:therapy; D008551:Melena / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009640:Norethindrone / Q000008:administration & dosage; D015282:Octreotide / Q000008:administration & dosage; D045167:Progesterone Congeners / Q000008:administration & dosage; D012008:Recurrence; D013915:Thrombasthenia / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome
D045166:Estradiol Congeners; D005765:Gastrointestinal Agents; D006490:Hemostatics; D045167:Progesterone Congeners; D004997:Ethinyl Estradiol; D015282:Octreotide; D009640:Norethindrone