TY - JOUR
T1 - Thrombocytopenia and gastrointestinal hemorrhage in the cancer patient
T2 - prevalence of unmasked lesions
AU - Chu, David Z.J.
AU - Shivshanker, K.
AU - Stroehlein, John R.
AU - Nelson, Robert S.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1983
Y1 - 1983
N2 - Some coagulation deficiencies are known to cause bleeding by unmasking existing gastrointestinal pathology, as opposed to directly causing mucosal blood loss. Characteristics and etiology of gastrointestinal hemorrhage associated with thrombocytopenia have not been analyzed. Our objectives were to correlate the distribution and cause of gastrointestinal bleeding, as diagnosed by fiberoptic endoscopy, with the severity of thrombocytopenia. One hundred thirty-three patients were divided into three groups, determined by platelet count at the time of bleeding (group A: <20,000/mm3; group B: 20,000 to 40,000/mm3; group C >40,000/mm3). Results of 187 endoscopies revealed unifocal sources of blood loss in over 50% of each group, and diffuse mucosal oozing independent of gastrointestinal pathology was seen in only 1% of group C. The only significant difference (p = 0.04) comparing unifocal, multifocal, and diffuse sources of bleeding was observed between groups A and C, wherein the distribution of multifocal or diffuse sources of bleeding was more common in group A. Esophagitis was more common and gastric ulceration less common in group A. No endoscopic complications occurred. Gastrointestinal bleeding associated with thrombocytopenia is most commonly due to co-existent gastrointestinal pathology as opposed to diffuse mucosal bleeding. Even when an inflammatory process, such as esophagitis or gastritis, affects a particular organ, bleeding is usually unifocal or mutifocal as opposed to diffuse even in the presence of moderately severe thrombocytopenia.
AB - Some coagulation deficiencies are known to cause bleeding by unmasking existing gastrointestinal pathology, as opposed to directly causing mucosal blood loss. Characteristics and etiology of gastrointestinal hemorrhage associated with thrombocytopenia have not been analyzed. Our objectives were to correlate the distribution and cause of gastrointestinal bleeding, as diagnosed by fiberoptic endoscopy, with the severity of thrombocytopenia. One hundred thirty-three patients were divided into three groups, determined by platelet count at the time of bleeding (group A: <20,000/mm3; group B: 20,000 to 40,000/mm3; group C >40,000/mm3). Results of 187 endoscopies revealed unifocal sources of blood loss in over 50% of each group, and diffuse mucosal oozing independent of gastrointestinal pathology was seen in only 1% of group C. The only significant difference (p = 0.04) comparing unifocal, multifocal, and diffuse sources of bleeding was observed between groups A and C, wherein the distribution of multifocal or diffuse sources of bleeding was more common in group A. Esophagitis was more common and gastric ulceration less common in group A. No endoscopic complications occurred. Gastrointestinal bleeding associated with thrombocytopenia is most commonly due to co-existent gastrointestinal pathology as opposed to diffuse mucosal bleeding. Even when an inflammatory process, such as esophagitis or gastritis, affects a particular organ, bleeding is usually unifocal or mutifocal as opposed to diffuse even in the presence of moderately severe thrombocytopenia.
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U2 - 10.1016/S0016-5107(83)72629-5
DO - 10.1016/S0016-5107(83)72629-5
M3 - Article
C2 - 6605893
AN - SCOPUS:0021028165
SN - 0016-5107
VL - 29
SP - 269
EP - 272
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -