Thrombocytopenia and gastrointestinal hemorrhage in the cancer patient: prevalence of unmasked lesions

Chu, David Z. J.; Shivshanker, Krishnamurthy; Stroehlein, John R.

doi:10.1016/s0016-5107(83)72629-5

Cited by 36 publications

(9 citation statements)

References 9 publications

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“…These agents were used in only three patients with GI bleeding because of the fear of bleeding complications. The scant number of ulcers found in our patient population is somewhat surprising, as previous studies have claimed that gastroduodenal ulcers and erosions are the principal cause of GI bleeding in patients with transient thrombocytopenia [9,32]. The rarity of peptic ulcer bleeding in our study population may have been due to the lack of aspirin or NSAID use and the relatively young age of our patients.…”

Section: Discussionmentioning

confidence: 56%

Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

et al. 2009

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Patients with thrombocytopenia caused by various neoplastic and primary bone marrow diseases are susceptible to major hemorrhage. There are few reports addressing the incidence and outcome of gastrointestinal (GI) bleeding in patients with aplastic anemia characterized by long-standing thrombocytopenia. We sought to retrospectively determine the incidence, etiology, clinical outcomes, and risk factors associated with overt GI bleeding in patients with aplastic anemia. We analyzed the medical records of 508 patients with aplastic anemia after excluding patients below 15 years of age or those who underwent stem cell transplantation between January 1, 2002, and December 31, 2007. A total of 32 patients developed overt GI bleeding during this period. We evaluated the site, etiology, outcomes, and major risk factors in these patients who developed GI bleeding episodes. The incidence of GI bleeding was 6.3% (32 of 508 patients) in adult patients with aplastic anemia. The incidence increased to 12.6% (28 of 222 patients) in patients with severe disease. One patient died from massive GI bleeding. Bleeding sites included the esophagus (two patients, 6.3%), stomach (five, 16.3%), duodenum (two, 6.3%), small intestine (five, 15.6%), large intestine (seven, 21.6%), and unknown site (11, 34.4%). Lower GI bleeds mainly caused by neutropenic enterocolitis (NEC) and solitary ulcer developed more frequently than upper GI bleeds. The major risk factors for GI bleeding included old age (P = 0.004, odds ratio (OR) = 1.039), severe aplastic anemia (P < 0.001, OR = 11.934), non-response to therapy (P = 0.001, OR = 5.652), and major bleeding history in another organ (P < 0.001, OR = 6.677). Overt GI bleeding in patients with aplastic anemia more frequently develops in the lower tract than in the upper tract. The risk of GI bleeding is higher in patients with the following risk factors: older age, severe disease, poor response to treatment, and major bleeding history in another organ.

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Section: Discussionmentioning

confidence: 56%

Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

et al. 2009

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“…UGI endoscopy with biopsy was shown to be safe in 1 study of adults with solid malignancies and platelet counts greater than 20,000/mL. 33 Two case series of UGI endoscopy with or without biopsies in children with platelet counts greater than 50,000/mL reported no bleeding adverse events. 34,35 However, a larger study of 198 UGI endoscopies in children after stem cell transplantation demonstrated that the risk of bleeding requiring red blood cell transfusions after UGI endoscopic biopsies was 4% despite a minimum platelet count of 50,000/mL.…”

Section: Infectious Adverse Eventsmentioning

confidence: 99%

Adverse events of upper GI endoscopy

Ben–Menachem¹,

Decker²,

Early³

et al. 2012

Gastrointestinal Endoscopy

307

170

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“…Thrombocytopenia and neutropenia are common in cancer patients for several reasons, predominantly bone marrow toxicity after chemotherapy and direct tumor effect. 1 Patients with cancer often have GI adverse events, particularly infectious GI tract diseases in the setting of neutropenia and bleeding in the setting of thrombocytopenia. Endoscopic procedures play a critical role in diagnosing and treating GI diseases.…”

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confidence: 99%