Abstract
Introduction: GI bleeding in patients with hematologic malignancies is not well studied. These patients tend to have lower platelet counts and/or dysfunctional platelets which are strong predisposing factors for bleeding distinguishing them from other groups. We aim to determine the various etiologies for GI bleeding and predictors of rebleeding in this group of patients. Methods: We performed a retrospective chart review of all individuals who underwent EGD and colonoscopy for overt bleeding between 2009 to 2011, at our institution. We studied the etiologies of GI bleeding and the incidence and risk factors for rebleeding among patients with hematologic malignancies. The study population was followed for rebleeding after their index bleeding episode. The predictors of rebleeding were determined using competing risk regression with death as a competing event. Results: The study population consisted of 79 patients with an index bleed, of which 50 underwent EGD and 44 underwent colonoscopy (15 had both). Amongst these, 13 (17%) had hematemesis, 31 (39%) had melena and 35 (44%) had hematochezia at presentation. The mean age of the patients was 61 years [58-64 at 95% CI], male:female ratio% was 57:43 and 72% were Caucasians. There were 40 patients with leukemia (51%), 28 with lymphoma (35%) and 11 with multiple myeloma (14%). The etiologies for bleeding have been described in tables 1 and 2. The median follow up time was 7.5 months (0.3 - 55.3) during which 16 patients had a rebleeding episode. The incidence of rebleeding was 1.2% [0.7-1.9 at 95% CI] per patient month. Patients with multiple myeloma were 3.5 times more likely to rebleed after adjusting for demographics, platelet count, INR and WBC count. Conclusion: In patients with hematologic malignancies, the presence of multiple myeloma and with underlying thrombocytopenia increases the risk of recurrent GI bleeding.Table 1: Etiology of Overt Gastrointestinal Bleeding Among Patients With Primary Hematologic Malignancies Who Underwent EGDTable 2: Etiology of Overt Gastrointestinal Bleeding Among Patients With Primary Hematologic Malignancies Who Underwent Colonoscopy
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