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Prolonged remission after life‐threatening gastrointestinal hemorrhage from coexistent angiodysplasia and acquired bleeding diathesis
Author(s) -
Woodlock Timothy J.,
Francis Charles W.,
Rowe Jacob M.,
Brown M. Julianne,
Marder Victor J.
Publication year - 1988
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830270211
Subject(s) - angiodysplasia , medicine , bleeding diathesis , cryoprecipitate , von willebrand factor , gastrointestinal bleeding , hemostasis , gastroenterology , platelet , duodenum , ristocetin , hemostatics , surgery
Abstract 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.