Abstract
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.
Highlights
Endoscopic procedures are known to be a possible cause of significant or uncontrolled bleeding
There 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 retrospective study from the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) group [11] on 311 surgical procedures in patients with polycythemia vera (PV) and essential thrombocythemia (ET) shows that the overall incidence of bleeding after surgery is of about 10 %, with a clear trend in subjects receiving antithrombotic prophylaxis and the hemorrhagic risk strongly related to the first 2 weeks of post-surgical period
Summary
In patients using antiplatelet drugs, surgeries involving mucous tissues, i.e. endoscopy polypectomy, has to be taken in due account because they may represent a relevant cause of delayed bleeding as the present case report shows. Consent Written informed consent was obtained from the patient for publication of this case report. Declarations Publication of this article was funded by University Hospital of Padova, Italy. Authors’ details 1Geriatric Surgery Unit, Geriatrics Department, University Hospital of Padova, via Giustiniani n.2. 9. Barosi G, Mesa RA, Thiele J, Cervantes F, Campbell PJ, Verstovsek S, Dupriez B, Levine RL, Passamonti F, Gotlib J, Reilly JT, Vannucchi AM, Hanson CA, Solberg LA, Orazi A, Tefferi A: Proposed criteria for the diagnosis of post-polyvythemia vera and post-essential thtombocythemia myelofibrosis: a consensus steatment from the international working group for myelofibrossis research and treatment. Ruggeri M, Rodeghiero F, Tosetto A, Castaman G, Scognamiglio F, Finazzi G, Delaini F, Micò C, Vannucchi AM, Antonioli E, De Stefano V, Za T, Gugliotta L, Tieghi A, Mazzucconi MG, Santoro C, Barbui T: Postsurgery outcomes in patients with polycytemia vera and essential thrombocythemia: a retrospective survey.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have