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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Angiodysplasia or vascular ectasia of the intestine is a new pathological entity which was initially revealed by arteriography. More recently it has been found by coloscopy and is considered to be responsible for many cases of intestinal bleeding, especially in older patients The present study is based on eight patients including 2 cases of microscopic bleeding, 4 of massive hemorrhage, and 2 asymptomatic cases. There is a clear difference between intestinal angiodysplasia and other forms of vascular malformations, even though its pathogenesis is still in question. Whereas in older patients it is acquired, typically in the caecum. It can also exist congenitally in younger patients and in other locations. However, identical lesions may be observed at all levels of the digestive tract in association with certain diseases, most often vascular atheroma, but also diverse intestinal diseases (diverticulitis, colitis, polyps, cancer) and even iatrogenic diseases. Even though these malformations are frequent, the lesions often go unrecognized because special histological technics are required to reveal the arteriovenous fistulas. The major circumstance leading to this diagnosis is anemia due either to occult intestinal bleeding or massive hemorrhage (after exclusion of prevalent associated disease such as diverticulosis). Occasionally latent angiodysplasia is revealed during studies undertaken for associated disease. Positive diagnosis is based on selective angiography during massive bleeding and on endoscopic examination in case of anemia from occult bleeding. Surgical treatment should be undertaken in case of major blood loss. This usually consists of resection of the ascending colon, the most frequent site of the lesion. It is recommended that an even longer colonic segment be resected in case of associated diverticulosis. The preferred treatment of limited forms with few symptoms depends on more recent technics such as endoscopic electrocoagulation. In conclusion, many cases if occult intestinal bleeding can be explained by angiodysplasia which thus deserves better understanding and recognition.
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PMID:[Angiodysplasias or vascular ectasias of the intestine. Report on 8 personal cases]. 698 52

The administration of intravenous immunoglobulin (IVIG) in immune and autoimmune diseases led us to use this agent to ameliorate or prevent the consequences of non-ABO incompatible transfusions in patients who need this form of therapy. IVIG (400 mg/kg/day) was infused within 24 h of transfusion in 5 patients with: (1) intestinal angiodysplasia, gastrointestinal bleeding, and anti-Kpb; (2) paroxysmal nocturnal hemoglobinuria, anti-c, anti E, anti Fyb, anti-K and autoantibodies; (3) lymphoma and autoimmune hemolytic anemia (AIHA); (4) systemic lupus erythematosus (SLE), AIHA, and anti-D, and (5) SLE and AHIA. A sustained increase in hematocrit was noted and no transfusion reaction developed in any of the cases. A single dose of pretransfusion IVIG may therefore be a useful therapeutic alternative in patients for whom no compatible blood is available. Patients with severe anemia, allo- and autoantibodies, either showing hemolysis in their pathophysiology or not, cause a serious problem in any transfusion center, especially when dealing with emergencies. In order to reduce the risks of incompatible transfusions, different modalities have previously been attempted, all with poor results. In 1989 we reported the successful use of pretransfusional high-dose intravenous immunoglobulin (IVIG) in a patient with gastrointestinal bleeding and anti-Kpb. The transfusion of incompatible red blood cells improved the anemia and allowed the exploratory laparotomy to take place. A protocol was then developed based on this case administering pretransfusion IVIG in high doses for patients for whom no compatible blood (non-ABO) is available.
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PMID:High-dose intravenous immunoglobulin in non-ABO transfusion incompatibility. 780 11

A 68-year-old woman with known severe aortic stenosis was admitted to the hospital because of hematochezia and dizziness. She had received several blood transfusions over the preceding 3 years and undergone right hemicolectomy 2 years ago for severe lower gastrointestinal bleeding. Postoperative histology revealed angiodysplasia involving the ascending colon. After the hemicolectomy, she continued to have hematochezia and anemia and required additional blood transfusions for anemia. During this admission, platelet count, activated partial-thromboplastin time, von Willebrand factor antigen, and von Willebrand factor ristocetin cofactor were normal. She had a severe deficiency of high-molecular-weight multimers of von Willebrand factor. Colonoscopy showed angiodysplasia in the transverse colon at this time. Successful coagulation of the bleeding angiodysplasia was achieved by argon plasma coagulator. No additional bleeding was observed thereafter. We report a case of Heyde's syndrome with abnormal von Willebrand factor in a patient who presented with intestinal angiodysplasia and aortic stenosis.
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PMID:[A case of Heyde's syndrome with abnormal von Willebrand factor]. 1497 72

Parasite infections of the digestive tract are a rare cause of acute haemorrhage in Western countries. We report here on a case of acute intestinal bleeding due to Taenia solium infection diagnosed at surgery. A 79-year-old white female patient was admitted to our institution for instable angina and severe anaemia secondary to acute intestinal bleeding. The patient's medical history was positive for long-standing microcytic anaemia. A recent diagnostic work-up had revealed the presence of chronic erosive antral gastritis and colonic diverticular disease without acute bleeding. On admission to our department the patient underwent antegrade bowel endoscopy which showed a bleeding site 120 cm caudad to the Treitz ligament in the absence of ulcers and/or neoplastic lesions. The patient was eventually referred to surgery for suspected intestinal angiodysplasia. At surgery no gross lesions of the stomach, bowel or colon were observed. We then performed a custom enterotomy 120 cm caudad to the Treitz ligament and discovered a 250-cm-long tapeworm. The parasite was removed with the aid of a second enterotomy 60 cm cephalad to the previous one and the entire bowel was explored with an intraoperative fiberoptic endoscope. Histology of the parasite revealed a T. solium species. The postoperative course was uneventful and the patient was discharged on postoperative day 10 with a prescription of 2 g/day niclosamide. No recurrent digestive bleeding has so far been reported after a follow-up of 8 months. T. solium infection is a common cause of chronic microcytic anaemia in tropical and subtropical areas. In Western countries intestinal parasite infections are rarely taken into account in the diagnostic work-up of patients affected with chronic anaemia and/or acute digestive bleeding. The mechanisms responsible for acute intestinal bleeding in tapeworm infections are poorly understood and could be related to parasite-induced erosions of the bowel wall or be secondary to manipulations occurring during diagnostic manoeuvres.
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PMID:[Acute intestinal bleeding due to Taenia solium infection]. 1503 62

Heyde syndrome is a triad of aortic stenosis, an acquired coagulopathy and anaemia due to bleeding from intestinal angiodysplasia. The evidence that aortic stenosis is the root cause of this coagulopathy is compelling. Resolution of anaemia usually follows aortic valve replacement. This article discusses studies linking aortic stenosis with other conditions in the triad as well as diagnosis and management of this complex pathology.
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PMID:Heyde syndrome: a common diagnosis in older patients with severe aortic stenosis. 1927 92

Iron deficiency is the single most prevalent nutritional deficiency worldwide. It accounts for anemia in 5% of American women and 2% of American men. The goal of this review article is to assist practitioners in understanding the physiology of iron metabolism and to aid in accurately diagnosing iron deficiency anemia. The current first line of therapy for patients with iron deficiency anemia is oral iron supplementation. Oral supplementation is cheap, safe, and effective at correcting iron deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient. Patients in whom the gastrointestinal blood loss exceeds the intestinal ability to absorb iron (e.g. intestinal angiodysplasia) may develop iron deficiency anemia refractory to oral iron supplementation. This population of patients proves to be the most challenging to manage. Historically, these patients have required numerous and frequent blood transfusions and suffer end-organ damage resultant from their refractory anemia. Intravenous iron supplementation fell out of favor secondary to the presence of infrequent but serious side effects. Newer and safer intravenous iron preparations are now available and are likely currently underutilized. This article discusses the possible use of intravenous iron supplementation in the management of patients with severe iron deficiency anemia and those who have failed oral iron supplementation.
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PMID:Diagnosis and management of iron deficiency anemia in the 21st century. 2169 2

Heyde syndrome is a triad of aortic stenosis, acquired coagulopathy, and anemia due to bleeding from intestinal angiodysplasia. Here we describe a case of this syndrome. An 80-year-old woman with severe aortic stenosis was referred to our department for an aortic valve replacement. She suffered from recurrent iron-deficiency anemia and required transfusions every 2 weeks. Gastroscopy and colonoscopy were normal with the exception of angiodysplasia without bleeding in the cecum. After aortic valve replacement her anemia was resolved. She was discharged on postoperative day 22. No transfusions were needed after the procedure. To date, her hemoglobin has remained stable at >10 mg/dL.
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PMID:A case of Heyde syndrome: resolution following aortic valve replacement. 2536 38

Heyde syndrome describes the triad of aortic stenosis, acquired coagulopathy, and anemia due to bleeding from intestinal angiodysplasia. An 87-year-old man with iron deficiency anemia due to melena was admitted to our hospital. On examination, a systolic murmur was heard and echocardiography confirmed the presence of aortic stenosis. Esophagogastroduodenoscopy and colonoscopy were unremarkable. Capsule endoscopy and double balloon endoscopy revealed angiodysplasia throughout the small intestine. Laboratory investigations were significant for reduced plasma levels of high molecular weight von Willebrand factor multimers. On the basis of these findings, the patient was diagnosed with Heyde syndrome. The patient required frequent blood transfusions because of the intestinal bleeding, and underwent bioprosthetic aortic valve replacement. Twenty months after the operation, the gastrointestinal bleeding resolved and the patient no longer required blood transfusions. This is the first case report to describe an improvement in bleeding from angiodysplasia, one year after aortic valve replacement. It demonstrates the effective treatment of Heyde syndrome with aortic valve replacement, and highlights the importance of considering this differential diagnosis when evaluating patients presenting with repeated episodes of gastrointestinal bleeding and a concurrent systolic murmur.
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PMID:Aortic Valve Replacement for the Management of Heyde Syndrome: A Case Report. 2897 1

Heyde's syndrome describes an association between aortic stenosis and a predisposition to bleeding from intestinal angiodysplasia resulting from acquired von Willebrand disease. We present the case of an 82-year-old woman with recurrent intestinal bleeding, severe anaemia and secondary myocardial infarction. Investigation identified ileal angiectasia as the source of haemorrhage. As echocardiography revealed severe aortic stenosis the patient underwent surgical valve replacement. At her 3-month follow-up, the patient reported no new bleeding episodes and her functional status had improved. This case highlights Heyde's syndrome, an entity probably underdiagnosed despite the high prevalence of aortic stenosis and intestinal angiodysplasia in elderly patients.
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PMID:You Can't Heyde Forever. 3075 64

Heyde's syndrome is a form of acquired von Willebrand syndrome that consists of bleeding from intestinal angiodysplasia in the presence of aortic stenosis (AS). An association with obstructive hypertrophic cardiomyopathy, rather than AS, by a similar mechanism has also been described. We report the case of a 78-year-old woman with chronic anaemia and hypertrophic obstructive cardiomyopathy in whom intestinal angiodysplasia with active bleeding was identified by an unconventional method. In this case, the authors describe a different approach to reach the correct diagnosis.
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PMID:Acquired von Willebrand Syndrome and Chronic Anaemia: A Different Diagnostic Approach. 3129 98


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