Bleeding In Pediatric Patients Research Articles

Adult to pediatric living donor liver transplantation for portal cavernoma

Portal cavernoma (PC) is an important cause of non-cirrhotic portal hypertension with severe complications, such as variceal hemorrhage in pediatric patients. With the development of new surgical techniques, living donor liver transplantation (LDLT) has recently been recognized as a viable but challenging treatment option for PC. The purpose of the present study was to summarize the efficacy of LDLT in PC patients and to carry out a follow-up study of pediatric recipients. The primary indication for LDLT in our research was PC with severe variceal bleeding and liver function decompensation. Three patients were diagnosed with PC following evaluation with computed tomography angiography and abdominal color Doppler ultrasonography (CDU). Various surgical techniques, including jump bypass grafting for portal vein anastomosis, were carried out according to the range and degree of cavernous transformation within the splenic vein and superior mesenteric vein. Postoperative CDU confirmed the early integrity of the portal vein (PV) in each patient. PV rethrombosis occurred in one patient 7 days after LDLT, despite anticoagulation therapy with coumadin. Two of the three patients had no further episodes of variceal hemorrhage during the 2-year follow-up period. The present study is the first report of the successful use of LDLT to treat pediatric PC patients. We conclude that LDLT is effective for the majority of pediatric patients with PC.

Use of Recombinant Factor VIIa (NovoSeven) in Pediatric Cardiac Surgery

Significant post-operative bleeding can be encountered in a small population of pediatric surgical patients requiring cardiopulmonary bypass (CPB). Recombinant factor VIIa (Novo-Seven) has been advocated as a possible off-label rescue therapy for these individuals when conventional blood component therapy alone is inadequate. This study retrospectively evaluates rFVIIa administration for the treatment of severe bleeding in pediatric patients immediately after cardiac surgical procedures requiring CPB. The records of 15 patients receiving rFVIIa for excessive rates of bleeding refractory to conventional blood component therapy were studied. Blood product utilization, rates of blood loss, and evidence of pathologic sequelae were compared with matched historical controls in retrospective fashion. NovoSeven doses ranged from 76 to 282 μg/kg (group 1 <30 kg) and 26 to 956 μg/kg (group 2 >30 kg). Blood product administration patterns were not significantly different (p > .05) in the intensive care unit (ICU) between patient groups receiving rFVIIa and those not treated. Bleeding rates (mL/kg/h) for the first 2 hours after admission to the ICU remained statistically unchanged but were significantly increased for those time periods >3 hours in patients <30 kg treated with NovoSeven. Patients >30 kg did not exhibit statistical differences in the rate of bleeding or the administration of blood products compared with matched controls. A significant reduction in prothrombin time (p = .001) and partial thromboplastin time (p = .02) was noted in patients <30 kg receiving rFVIIa. There were no pathologic sequelae directly attributed to the administration of rFVIIa in any patients treated. Trends in the improvement of bleeding disturbances were noted in the ICU in patients <30 kg treated with rFVIIa, subsequent to blood component therapy. The rate of bleeding (mL/kg/h) was improved in patients <30 kg for the first 2 hours in the ICU. For individuals >30 kg, there was no apparent benefit from the administration of rFVIIa.

The Effectiveness of Recombinant Factor VIIa in the Treatment of Bleeding in Pediatric Patients: A Ten-Year Experience from 1997 to 2007.

Introduction: Recombinant factor VIIa (rFVIIa) has been used in the treatment of bleeding in Thailand since 1997.Methods: 125 patients receiving rFVIIa at the Faculty of Medicine, Ramathibodi Hospital and Regional Hospitals from 1997 to 2007 were retrospectively evaluated. Their age group ranged from newborn (n=11), infants (n=21), children (n=86) to adolescents (n=7). They were divided into 2 groups. Group 1 included 11 hemophiliacs with high inhibitor (A10, B1) exhibiting 90 episodes of bleeding or undergoing surgeries. The rFVIIa 100–200 μg/kg at 1–2 h interval for 1–4 doses combined with prednisolone, transamine, fibrin glue and dental splint were given. In cases of surgery, 100 μg/kg at 1–2 h interval was given in the first 24 h and extended to 3–4 h until the removal of stitches or 7–14 days after the surgical procedures. Sequential use of rFVIIa with non-activated or activated prothrombin complex concentrates were given to 9 patients. Group 2 included 114 non-hemophiliacs with or without pre-existing hemostatic disorder for controlling excessive bleeding unresponsive to conventional blood components or for preventing bleeding in invasive procedures. There were 122 episodes involving patients with Dengue Hemorrhagic Fever (n=38), massive bleeding (n=49), invasive procedure (n=23), Glanzmann thrombasthenia (n=6), congenital factor VII deficiency (n=5) and acquired aplastic anemia (n=1). For controlling excessive bleeding, 40–100 μg/kg of rFVIIa was given at 15–30 min interval for 1–4 doses until the bleeding significantly reduced, followed by 40–100 μg/kg at 2–4 h interval for 24–48 h until the bleeding was completely ceased. For preventing bleeding in invasive procedures, the similar regimen but with a lower fixed dose of 40–100 μg/kg was used. One to two doses were usually used. An exceptional high dose of 200–300 μg/kg was used in patients with Glanzmann thrombasthenia and a lower dose of 20–30 μg/kg at 6 h interval was used in patients with congenital factor VII deficiency.Results: The efficacy of controlling bleeding in hemophiliacs revealed effective (80/90, 88.9%), partially-effective (6/90, 6.7%) and ineffective (4/90, 4.4%) responses while the non-hemophiliacs revealed effective (81/122, 88.5%), partially-effective (14/122, 11.5%) and ineffective (27/122, 22.1%) responses. The case-fatality rates were 0% and 27.2% (31/114) in hemophiliacs and non-hemophiliacs, respectively. Three episodes of thrombosis (3/125, 2.4%) were found 3 children underwent cardiac surgery.Conclusion: rFVIIa has shown an effectiveness in the treatment of bleeding in pediatric patients with hemophiliacs and non-hemophiliacs.

RFVIIa in the treatment of persistent hemorrhage in pediatric patients on ECMO following surgery for congenital heart disease

Patients who require extracorporeal membrane oxygenation (ECMO) postsurgery for congenital heart disease (CHD) frequently experience severe bleeding episodes. Whereas recombinant-activated factor VII (rFVIIa) has proven efficacy in counteracting intractable hemorrhage in various scenarios, its use in patients on ECMO is limited by the increased risk for thrombotic events. Between December 2004 and January 2006, ECMO was used in 10 pediatric patients following cardiac surgery, of whom seven were treated with rFVIIa because of intractable hemorrhage. Their medical records were reviewed with respect to variations in chest tube output and transfusion requirements, occlusion of or thrombus formation in the ECMO circuit and the occurrence of thromboembolic events. Outcome and rate of ECMO circuit occlusion were compared with historic controls. Three patients died, and four survived (none of the deaths was attributable to thrombus formation or bleeding). All patients were treated with aprotinin prior to and during rFVIIa therapy. Two patients developed an occlusion of the oxygenator, one after receiving co-medication with a FXIII concentrate, another after RBC transfusion in the ECMO system. In two patients, thrombus formation was observed in the ECMO system on inspection after discontinuation. Thromboembolic events were not observed. Recombinant-activated factor VII in a median dosage of 90 microg.kg(-1) was used in seven pediatric patients on ECMO. Rates of ECMO system occlusions and mortality did not differ from historic controls. Neither the reduction of chest tube output nor the blood product transfusion requirements did reach statistical significance.

Gastric pH, GI Tract Bleeding, and Acid Suppression Therapy in Pediatric Patients

Crill CM, Hak EB. Upper gastrointestinal tract bleeding in critically ill pediatric patients. Pharmacotherapy 1999;19:162180. This paper discusses developmental issues that affect the occurrence and prophylaxis of upper gastrointestinal tract bleeding in pediatric patients. It reviews the diagnosis, frequency, and risk factors for this disorder, while noting differences between pediatric and adult patients. A review of nonpharmacological and pharmacological prophylaxis and treatment is presented, complete with dosing guidelines and pharmacokinetic data. The authors incorporated economic and monitoring issues, while making recommendations for therapy.

ENDOCLIPS TO TREAT SEVERE GI BLEEDING IN PEDIATRIC PATIENTS

Background: Endoclips are metal devices that can be applied to the GI mucosa through flexible endoscopes. They have been used in adults to treat GI bleeding and luminal perforation. In pediatrics use of endoclips has been reported in the closure of gastrocutaneous fistulas. Traditional therapy for GI bleeding in pediatric patients often involves thermal techniques which expose patients to the possibility of excessive tissue injury. This series describes successful use of endoclips combined with injection of epinephrine in the treatment of severe GI bleeding in 4 pediatric patients. Methods: 4 children (12-17 yrs) with acute, transfusion dependent GI bleeding were treated with endoclips during a 3 month period. Underlying diagnoses included small bowel transplant with anastomotic ulcers, ALL with gastric ulcers, hemophagocytic lymphohistiocytosis with cecal ulcer, and empyema with duodenal ulcer. All required ICU care and 3 were on octreotide infusions. Preoperative trough Hgb ranged from 6.3-7.8 g/dL (mean 6.9). On endoscopy, 3 patients had actively bleeding ulcers, one with a visible vessel. One had anastamotic ulcers with stigmata of recent, but not active bleeding. Epinephrine (1:10,000) was injected around all lesions, and 2 or 3 endoclips were applied to the lesions, closing the defects. Results: Hemostasis was achieved in all patients. Postoperatively, trough Hgb for each patient ranged from 8.6 to 10.1 g/dL (mean 9.3) during the first 3 days. GI bleeding appeared to resolve in all patients during the postoperative period manifested by clearing of NG, rectal or ileostomy output, improvement in Hgb, and decreased transfusion requirement. Ultimately all patients required additional transfusions due to underlying diagnoses. One underwent repeat EGD with injection of epinephrine and clipping of an additional gastric ulcer 5 days later. There were no complications and no rebleeding of treated lesions. Conclusions: The use of endoclips in conjunction with epinephrine injection in the treatment of severe, acute GI bleeding is a feasible and possibly preferable alternative to thermal techniques in pediatric patients.

Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review

To determine whether hydrogen peroxide (H(2)O(2)) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Tertiary otolaryngology center. Of the 156 patients, 59 received H(2)O(2) and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H(2)O(2) group) and 1.6 days (control group). In the H(2)O(2) group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H(2)O(2) group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration (P = 0.49), rate of surgical intervention (P = 0.85), and rate of readmission with further hemorrhage (P = 0.92). Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. This study does not support the common practice of treating post-tonsillectomy hemorrhage with H(2)O(2).

Arterial spasm following perimesencephalic nonaneurysmal subarachnoid hemorrhage in a pediatric patient

Perimesencephalic nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhages. This entity is well recognized as a distinct type of subarachnoid hemorrhage in adults. However, perimesencephalic nonaneurysmal subarachnoid hemorrhage in pediatric patients is not well recognized. Angiographic changes such as vasospasm are uncommon in patients, especially in pediatric patients suffering from this type of hemorrhage. This case study reports a 12-year-old male who suffered from perimesencephalic nonaneurysmal subarachnoid hemorrhage. Cerebral carotid angiography performed on the tenth day of the posthemorrhagic period revealed severe vasospasm affecting the basilar artery. The patient, treated symptomatically, was discharged after improvement. One year later, magnetic resonance angiography revealed completely normal features.

Wireless capsule endoscopy for obscure small-bowel disorders: Final results of the first pediatric controlled trial

Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.

The Use of Recombinant Activated Factor VII for Controlling Bleeding in Pediatric Patients Undergoing Invasive Surgeries.

Objective: Recombinant activated factor VII (rFVIIa) in controlling the pre-existing life-threatening bleeding and in preventing excessive bleeding among pediatric patients undergoing invasive surgeries, was evaluated.Methods: An open-label, prospective uncontrolled study of rFVIIa (Novo Nordisk A/S Bagvaerd, Denmark) was conducted between January 2000 to July 2004. A bolus injection of 40–100 μg/kg of rFVIIa as a single or repeated doses at 15–30 min was given until the bleeding significantly reduced, followed by 40 μg/kg at 4 h interval until the bleeding was completely ceased. The patients were divided into 2 groups. Group 1 consisted of 11 patients receiving rFVIIa for controlling pre-existing life-threatening bleeding unresponsive to conventional replacement therapy at pre-(n=1), intra-(n=1) and post-operation (n=9). The median blood loss was 2.2 ml/kg/min at the median duration of 3 h prior to rFVIIa administration. Group 2 consisted of 9 patients receiving rFVIIa for preventing excessive bleeding from invasive surgeries. The surgeries included exploratory laparotomy (n=5), surgery of cardiac (n=5), liver (n=4), brain (n=2) and lung (n=1), liver transplantation (n=1), orthopedic corrective surgery of scoliosis (n=1), and orbital translocation (n=1).Result: Two patients were the premature neonate of 1,120 and 675 g in the first 24 h of life and 17 were children with a median age of 5 years. One patient had two subsequent surgeries, 6 months apart. They had no pre-existing hemostatic disorders. Patients in group 1 were in the state of threatened shock to profound shock. Due to massive transfusion, they exhibited dilutional coagulopathy and thrombo-cytopenia. The treatment was considered effective response in 17 cases (17/20=85%), including 8 patients (8/11=72.7%) in group 1 and 9 patients (9/9=100%) in group 2. They had a complete cessation of bleeding with no recurrence. Ineffective responses were found in 3 patients (3/20=15%) in group 1. One patient exhibited massive pulmonary hemorrhage from complicated lobar pneumonia which was unresponsive to right lower lung lobectomy. The other two patients, whose bleeding temporarily slowed down, required the re-explorations revealing a tear at the right atrium and a leak at the hepatic anastomosis site respectively. Although the rFVIIa combined with adequate amounts of blood components were given, the median intra-operative blood loss among 4 patients in group 1 was 0.3 ml/kg/min which was significantly higher than that of group 2 (0.1 ml/kg/min) p=0.014. The median total dose of rFVIIa in group 2 (60 μg/kg) was significantly lower than that in group 1 (120 μg/kg) p=0.037. Ultimately, 2 patients died while all patients in group 2 survived. No clinical evidences of thrombo-embolic complication were observed.Conclusion: The rFVIIa seems to be effective in controlling life-threatening bleeding and in preventing excessive bleeding in a limited series of pediatric patients undergoing invasive surgeries. Further study is warranted.

Liver biopsy complicated by hemorrhage in a patient with ARC syndrome

ARC syndrome is a rare disorder consisting of arthrogryposis, renal tubular acidosis and cholestatic liver disease. We report the case of a 5-week-old patient who underwent a percutaneous liver biopsy complicated by hemorrhage, and was subsequently diagnosed with ARC syndrome. A review of the literature demonstrates that these patients are at increased risk of bleeding caused by platelet dysfunction. The evaluation and management of unexpected hemorrhage in pediatric patients as a result of undiagnosed congenital bleeding problems is discussed.

Effective chemical preservation of morphology of urinary erythrocytes.

Between 2 and 4 h after miction the morphology of urinary erythrocytes has changed, clouding the distinction between glomerular and non-glomerular bleeding in pediatric patients. Glomerular bleeding is characterized by microscopically visible alteration in urinary erythrocytes due to glomerular disease. Fixation by Cellfix, a formaldehyde-based fixative, allows the preservation of the morphology for at least 24 h and can be recommended for clinical practice. In our experience, thiomersal was not effective for preservation of the morphology of erythrocytes.

Value of Preoperative Prothrombin Time/Partial Thromboplastin Time as a Predictor of Postoperative Hemorrhage in Pediatric Patients Undergoing Tonsillectomy

Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. A retrospective chart review was carried out with a minimum of 1 month follow-up. Tertiary academic referral center. Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study. Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined. Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.

Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy

OBJECTIVE: Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. DESIGN: A retrospective chart review was carried out with a minimum of 1 month follow-up. SETTING: Tertiary academic referral center. PATIENTS: Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study. MAIN OUTCOME MEASURE: Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined. RESULTS: Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient [12.5%] with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. CONCLUSIONS: Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history. (Otolaryngol Head Neck Surg 1997;117:628-32.)

Vaginal Bleeding in Pediatric Patients

<h3>Background</h3> The purpose of this study <i>is</i> to evaluate the underlying cause of vaginal bleeding in all pediatric patients and to specifically evaluate the underlying cause of menorrhagia. <h3>Methods</h3> This retrospective chart review examined 134 patients with the coded diagnosis of vaginal bleeding seen at a tertiary children's medical center either emergency or outpatient setting from January, 1993 to April, 1996. <h3>Results</h3> One hundred thirty-four charts were reviewed with 79 (59.0%) seen initially in emergency department and 55 (41.0%) seen in an outpatient setting. There were 3 admissions (2.2%). The age range was 4 days to 20 years: <28 days=13 (9.7%); 29 days to 2 years=10 (7.5%); 2 years to 9 years=14 (10.4%); and > 9 years=97 (72.4%). The most common diagnoses were breakthrough bleeding with a birth control method (31 or 23.1%), dysfunctional uterine bleeding (24 or 17.9%), abnormal uterine bleeding (20 or 14.9%), neonatal withdrawal (12 or 9.0%), trauma including sexual abuse (9 or 6.7%), spontaneous abortion (8 or 6.0%), vulvovaginitis (8 or 6.0%), and miscel1aneous other diagnosis (menses, vaginal polyp, vaginal yolk sac tumor, foreign body, and central precocious puberty). The common causes of vaginal bleeding were age-related. In the neonates, 92.3% (12/13) of vaginal bleeding was due to neonatal estrogen withdrawal. In the 2 to 9 year old children, 42.9% (6/14) of vaginal bleeding was caused by trauma with half due to sexual abuse; 42.9% (6/14) was due to vulvovaginitis. In the adolescents (>9 years old), 32.0% (31/97) of vaginal bleeding was due to birth control method including depo provera, Norplant and oral contraceptives in order of frequency. The coded diagnoses of dysfunctional uterine bleeding and abnormal uterine bleeding accounted for 25.8% (25/97) and 16.5% (16/97) of adolescent vaginal bleeding, respectively. Eight percent (8/97) of adolescents had spontaneous abortions. For the purpose of analysis, menorrhagia was defined as heavy vaginal bleeding (>1 pad per hour) or prolonged bleeding (>7 days) with clinical evidence of bleeding such as blood on pelvic exam or anemia (hemoglobin< 11.5g/dl or hematocrit <35.0%). All 21 patients (15.7% of all patients) with menorrhagia were between the ages of 10 to 20 years accounting for 21.6% (21/97) of adolescent vaginal bleeding. Menorrhagi was due to dysfunctional uterine bleeding in 57.1% (12/21) and a coagulopathy in 19% (4/21). The most common coagulopathy was von Willebrand's disease, found in 2 cases, followed by liver disease in 1 case and thrombocytopenia from aplastic anemia in 1 case. One case of menorrhagia was due to bleeding from Norplant, and 1 case was due to bleeding after a LEEP procedure to the cervix. <h3>Conclusions</h3> The most common causes of vaginal bleeding in pediatric patients are age-related. In children and neonates, neonatal withdrawal, vulvovaginitis and trauma including sexual abuse are most common. In adolescents, bleeding from a birth control method and dysfunctional uterine bleeding are most common. Menorrhagia was seen in 21% of our adolescents, and this study reflects prior data with 19% of adolescents with menorrhagia having an underlying coagulopathy.

65 COLONIC ANGIODYSPLASIA PRESENTING IN PEDIATRIC PATIENTS.

Although angiodysplasia of the colon is diagnosed frequently in the elderly, it is a very rare cause of massive lower gastrointestinal bleeding in children. We report two pediatric patients ages 13 and 15, in whom life threatening gastrointestinal hemorrhage was due to colonic angiodysplasia. Both patients were in good health until they presented with painless rectal bleeding. Physical exam was unremarkable except for orthostasis. Both patients had severe anemia at presentation with hemoglobin levels ranging from 4.4 to 8.9 g/dl. Colonoscopy and angiography established the diagnosis. Both patients had ileocecal involvement; one patient also had rectal and perianal lesions. Both underwent ileocecal resection with significant improvement postoperatively. One patient has required endoscopic sclerotherapy for lesions in the rectum. Although vascular malformations account for a minority of episodes of lower gastrointestinal bleeding in pediatric patients, the occurrence of these lesions should be considered in the differential diagnosis of severe gastrointestinal hemorrhage in children.

Feasibility of Meckel??s Scan After RBC Gastrointestinal Bleeding Study Using In???Vitro Labeling Technique

The authors report a successful Meckel's scan performed 26 hours after a labeled RBC study using a commercial in-vitro labeling kit, UltraTag (Mallinckrodt Medical, Inc., St. Louis, MO). No abnormal alteration of Tc-99m distribution was observed as would be seen if an in-vivo RBC labeling technique was used. This case demonstrates that it is feasible to perform an in-vitro labeled RBC study for acute gastrointestinal bleeding in pediatric patients and to follow-up with a Meckel's scan if it is necessary for diagnostic confirmation.

Emergency Endoscopy for Gastrointestinal Bleeding in Pediatric Patients

Emergency Endoscopy for Gastrointestinal Bleeding in Pediatric Patients

Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus

Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus

Evaluation of glomerular and nonglomerular hematuria by phase-contrast microscopy

Glomerular and nonglomerular origins of hematuria may be identified by assessment of the shape and size of the excreted red blood cells. We examined 380 urine specimens from 179 children with hematuria (greater than or equal to 3500 RBC/minute) with phase-contrast microscopy. In 106 cases, the cause was known; the results agreed with the clinical, histologic, and laboratory diagnosis in 63 of 65 subjects (97%) with glomerulopathies and in 39 of 41 (95%) with nonglomerular hematuria. Casts were found in 54% of the specimens from the children with definite glomerular hematuria. Phase-contrast microscopic examination of red blood cells in the urine is a simple, inexpensive, and noninvasive technique that permits an accurate distinction between glomerular and nonglomerular bleeding in pediatric patients.