Successful control of massive gastrointestinal bleeding following umbilical cord blood transplantation (UCBT) by use of recombinant activated factor VII (rFVIIa) and octreotide infusion.
Post hematopoietic stem cell transplantation (HSCT) gastrointestinal (GI) bleeding is a dreaded complication. There are only five other reports (one randomised trial and four case reports) of use of rFVIIa for massive lower GI bleeding post-allogeneic HSCT. In only one publication, two adult patients showed complete response. Eroglu has reported a response rate of 50% to octreotide in gastrointestinal bleeding in patients without portal hypertension. We present a 10 month-old female child, who had three episodes of life threatening lower GI bleeding post unrelated Umbilical Stem Cell Transplant (UCBT) controlled successfully each time by use of rFVIIa and octreotide infusion and review of literature. To our knowledge this is the first and youngest case reported, in which both rFVIIa and octreotide have been used successfully to control life threatening lower GI bleeding post UCBT.
Yadav
Satya Prakash
SP
Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India. satya_1026@hotmail.com
Sachdeva
Anupam
A
Bhat
Sunil
S
Katewa
Satyendra
S
D016026:Bone Marrow Transplantation; D036101:Cord Blood Stem Cell Transplantation; D051799:Delayed Graft Function; D004359:Drug Therapy, Combination; D017707:Erythrocyte Transfusion; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010949:Plasma; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000209:etiology; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D013921:Thrombocytopenia / Q000209:etiology; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017086:beta-Thalassemia / Q000150:complications / Q000601:surgery
D006490:Hemostatics; D011994:Recombinant Proteins; D014148:Tranexamic Acid; C103587:recombinant FVIIa; D015942:Factor VIIa; D015282:Octreotide