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

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Abstract
Coppola A, De Stefano V, Tufano A, Nardone G, Amoriello A, Cerbone AM, Di Minno G (Centro di Coordinamento Regionale per le Emocoagulopatie; Università‘Federico II’, Napoli; A.O.R.N. ‘A. Cardarelli’, Napoli; Italy). Long‐lasting intestinal bleeding in an old patient with multiple mucosal vascular abnormalities and Glanzmann's thrombasthenia 3‐year pharmacological management (Case report). J Intern Med 2002; 252: 271–275. 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.