Simultaneous detection of lower gastrointestinal bleeding and hepatic hemangioma in a scintigraphy study with red blood cells labeled with 99mTc-stannous pyrophosphate

A 75-year-old woman, under study for signs and symptoms of microcytic hypochromic anemia of 3-year progression, was treated on several occasions with oral iron supplementation and blood transfusions. She presented with hemorrhoidal pathology and dark stools related to iron therapy. Her latest control laboratory work-up reported Hb 10 g/dl, MCV 72 f/l, iron 47 g/dl, ferritin 250 ng/ml, vitamin B12 378 pg/ml, and folic acid 6 ng/ml. Upper gastrointestinal endoscopy revealed mild erythematous gastritis, with a large sliding hiatal hernia, and colonoscopy showed internal hemorrhoids and a spastic colon. There were no signs of active bleeding in either study. Due to the suspicion of occult bleeding, scintigraphy with red blood cell labeling with Tc-stannous pyrophosphate (Fig. 1A and B) and abdominal SPECT/CT