Intraarterial Platelet Infusion for Patients with Intractable Gastrointestinal Hemorrhage and Severe Refractory Thrombocytopenia

Intra-Arterial Platelet Infusion for Intractable Hemorrhage and Refractory Thrombocytopenia in Children With Gastrointestinal Graft-Versus-Host Disease

Acute gastrointestinal graft-versus-host disease (GVHD) refractory to first-line treatment with systemic corticosteroids results in increased morbidity and potential mortality. We retrospectively assessed the feasibility and efficacy of catheter-directed intra-arterial platelet infusion (IAPI) in two pediatric patients with steroid and transfusion refractory gastrointestinal GVHD causing intractable lower gastrointestinal hemorrhage and refractory thrombocytopenia, that were referred for salvage therapy. Immediate angiographic response was noted with a resolution of hemorrhage and decreased blood requirements. We reviewed the literature regarding this treatment modality and compared it to the available minimally invasive transcatheter techniques to control gastrointestinal hemorrhage.

Management of acquired bleeding problems in cancer patients

Cancer patients can have acquired bleeding problems for many reasons. In this review, an approach to the evaluation and management of the bleeding patient is discussed. Specific issues including coagulation defects, thrombocytopenia, platelet dysfunction, and bleeding complications of specific hematological malignancies due to anticoagulation, are discussed.

Management of acquired bleeding problems in cancer patients

Cancer patients can have acquired bleeding problems for many reasons. In this review, an approach to the bleeding patient in the Emergency Department is discussed. Specific issue including coagulation defects, thrombocytopenia, platelet dysfunction, bleeding complications of specific hematological malignancies and due to anticoagulation, are discussed.

Interventional management of lower gastrointestinal bleeding

Lower gastrointestinal bleeding (LGIB) arises from a number of sources and is a significant cause of hospitalization and mortality in elderly patients. Whereas most episodes of acute LGIB resolve spontaneously with conservative management, an important subset of patients requires further diagnostic workup and therapeutic intervention. Endovascular techniques such as microcatheter embolization are now recognized as safe, effective methods for controlling LGIB that is refractory to endoscopic intervention. In addition, multidetector CT has shown the ability to identify areas of active bleeding in a non-invasive fashion, enabling more focused intervention. Given the relative strengths and weaknesses of various diagnostic and treatment modalities, a close working relationship between interventional radiologists, gastroenterologists and diagnostic radiologists is necessary for the optimal management of LGIB patients.

Transcatheter treatment for lower gastrointestinal hemorrhage

Modern transcatheter embolization has emerged as a viable option for the treatment of lower gastrointestinal (LGI) hemorrhage. Over the last decade, steady data has accumulated showing the safety and effectiveness of superselective microcoil embolization within the colon. In light of such results, the application of microcatheter-based skills has become more important in an algorithm for managing LGI bleeding. The purpose of this article is to discuss the modern embolization technique while also reviewing traditional and experimental transcatheter methods that may prove useful in the appropriate clinical settings. While recognizing that transcatheter therapy continues to evolve, the proposed indications for these current treatments are reviewed.