Severe delayed postpolypectomy bleeding in elder patient with post-polycythemia myelofibrosis

BMC Surgery

Research Article

Maria Luigia Randi¹  Fabrizio Cardin²  Carmelo Militello²  Marco Mosele²  Claudio Terranova³ 

[1] Department of Medical and Surgical Sciences, University Hospital of Padova, via Giustiniani n.2, Padova, Italy;Geriatric Surgery Unit, Geriatrics Department, University Hospital of Padova, via Giustiniani n.2, Padova, Italy;Section of Legal Medicine, Department of Molecular medicine, University Hospital of Padova, via Falloppio n.50, 35121, Padova, Italy;

关键词: Polycythemia Vera;    Essential Thrombocythemia;    Myelofibrosis;    Antiplatelet Drug;    JAK2V617F Mutation;   

DOI  :  10.1186/1471-2482-13-S2-S18

来源: Springer

【 摘 要 】

BackgroundThe interest of the case lies in an unexpected delayed bleeding following an endoscopic procedure in a patient with post-polycythemia myelofibrosis. The case gives the opportunity to discuss the medical management and monitoring of patients with myeloproliferative disorders undergoing minimally invasive surgery interventions.Case presentationA 75 years old woman affected by post-polycythemia myelofibrosis underwent endoscopy polypectomy followed by a delayed major local bleeding. At the time of the endoscopy followed by bleeding, the platelet count was 837 × 109/L, haemoglobin 113 g/L, PCV 35,2% and WBC 20.22 × 106/L. No antithrombotic prophylaxis with low molecular weight heparin was used. Antiplatelet drug was withdraw seven days before endoscopy and restarted one week after the procedure. Polyp size was 11x19 mm and it was located on right side of the colon.Fourteen days after procedure the patient developed a severe lower intestinal bleeding, which required RBC transfusion; the bleeding was in the site of polypectomy as demonstrated by arteriography; selective embolization of the three branches of the ileo-colic artery resolve the haemorrhage.ConclusionThere are some patients in whom current guidelines do not apply and our case stress the importance of myeloproliferative neoplasms as a risk factor for complications of endoscopic polypectomy. The delayed haemorrhage we observed suggest to strictly control the patient for a period longer than only one week also in case of antithrombotic treatment with antiplatelet drugs.

【 授权许可】

CC BY   
© Cardin et al; licensee BioMed Central Ltd. 2013