Successful Control of Massive Gastrointestinal Bleeding Following Umbilical Cord Blood Transplantation (Ucbt) by Use of Recombinant Activated Factor Vii (Rfviia) and Octreotide Infusion

Abstract

Post hematopoietic stem cell transplantation (HSCT) gastrointestinal (GI) bleeding is a dreaded complication. There are only five other reports (one randomised trial and four case reports) of use of rFVIIa for massive lower GI bleeding post-allogeneic HSCT. In only one publication, two adult patients showed complete response. Eroglu has reported a response rate of 50% to octreotide in gastrointestinal bleeding in patients without portal hypertension. We present a 10 month-old female child, who had three episodes of life threatening lower GI bleeding post unrelated Umbilical Stem Cell Transplant (UCBT) controlled successfully each time by use of rFVIIa and octreotide infusion and review of literature. To our knowledge this is the first and youngest case reported, in which both rFVIIa and octreotide have been used successfully to control life threatening lower GI bleeding post UCBT.

Recombinant Activated Factor VII Usage in Life Threatening Hemorrhage: A Pediatric Experience

“…In children off label usage of rFVIIa use has been reported for bleeding after congenital heart surgery, during liver transplantation, severe GI hemorrhage, pulmonary hemorrhage, trauma, intracranial hemorrhage, DIC and intra operatively for brain tumors [13][14][15][16][17][18][19][20]. Use has been reported pre-procedurally in coagulopathic leukemic patients requiring lumbar puncture [21].…”

Use of recombinant factor VIIa in uncontrolled gastrointestinal bleeding after hematopoietic stem cell transplantation among patients with thrombocytopenia

“… 2 , 3 If platelet refractoriness is associated with GI bleeding, routine hemostatic interventions may not help. 11 Most patients in our case series remained dependent on platelet transfusion, five patients became platelet transfusion refractoriness, which would contribute to the failure of the hemostatic therapy.…”

“… 17 Until now, the use of this agent in patients with hematological malignancies suffering from GI bleeding following HSCT has been mostly described in anecdote case reports. 7 , 11 , 15 The only randomized trial available in the literature was published by Pihusch et al . 18 One hundred patients with moderate or severe bleeding (including 52 gastrointestinal) following HSCT received seven doses of rFVIIa, an improvement in the control of bleeding for the rFVIIa 80μg/kg group versus the standard hemostatic treatment group was observed, while there were no differences in transfusion requirements across dose groups (40, 80 or 160μg/kg).…”

Complex Transfusion Issues in Pediatric Hematopoietic Stem Cell Transplantation

“…However, subsequent case reports have noted efficacious use of rFVIIa as an adjuvant therapy to stop significant GI bleeding in patients following HSCT [59,60], including one pediatric patient [61]. Antifibrinolytic therapy has been used successfully to support autologous transplants in adult patients who wish to avoid homologous transfusion support [62,63], but its role in allogeneic HSCT to prevent bleeding is unclear.…”