Long-lasting intestinal bleeding in an old patient with multiple mucosal vascular abnormalities and Glanzmann's thrombasthenia: 3-year pharmacological management

J Intern Med. 2002 Sep;252(3):271-5. doi: 10.1046/j.1365-2796.2002.01023.x.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anemia / etiology
  • Anemia / therapy
  • Angiodysplasia / complications*
  • Angiodysplasia / diagnosis
  • Angiodysplasia / therapy
  • Blood Transfusion
  • Drug Therapy, Combination
  • Electrocoagulation
  • Estradiol Congeners / administration & dosage
  • Ethinyl Estradiol / administration & dosage
  • Female
  • Gastrointestinal Agents / administration & dosage
  • Hemostatics / administration & dosage
  • Humans
  • Intestinal Diseases / complications*
  • Intestinal Diseases / therapy
  • Melena / diagnosis
  • Melena / etiology*
  • Melena / therapy
  • Norethindrone / administration & dosage
  • Octreotide / administration & dosage
  • Progesterone Congeners / administration & dosage
  • Recurrence
  • Thrombasthenia / complications*
  • Thrombasthenia / drug therapy*
  • Treatment Outcome

Substances

  • Estradiol Congeners
  • Gastrointestinal Agents
  • Hemostatics
  • Progesterone Congeners
  • Ethinyl Estradiol
  • Octreotide
  • Norethindrone