Abstract
A 42-year-old man presented with acute hematochezia and orthostasis. His past medical history included paroxysmal nocturnal hemoglobinuria associated with portal vein thrombosis for which he underwent a stem cell transplant. Several years later, endoscopy revealed nonbleeding esophageal and gastric varices, portal hypertensive gastropathy, and colopathy. A liver biopsy for chronically increased alkaline phosphatase levels revealed nodular regenerative hyperplasia. Ten years after transplant, he developed iron-deficiency anemia and intermittent melena requiring frequent transfusions.
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