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Immunologically mediated skin disorders
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Classic findings of purpura, arthralgia, and abdominal pain are seen (Figure 5.19). Renal involvement with HSP is common, presenting as hematuria and proteinuria. Gastrointestinal bleeding may occur. Painful arthritis affects knees and ankles.
Management of lower gastrointestinal bleeding
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The key aspect of managing lower gastrointestinal bleeding is establishing the source of blood loss to allow appropriately directed therapy. Within the spectrum of presentation of these patients it is important to distinguish two groups – the more unusual presentation with an acute onset and the more common problem of occult gastrointestinal bleeding presenting with anaemia or being detected on the basis of positive faecal occult blood testing.
Congenital Platelet Dysfunction and von Willebrand Disease
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
A 52-year-old man has had a life-long history of easy bruising. As a child, he recalls excessive bleeding following relatively minor cuts and scratches, and nosebleeds often requiring more than 30 min to stop. The epistaxis was bilateral, and was treated multiple times by cauterization. The patient frequently experiences bleeding of the gums in association with tooth brushing, and occasionally even from eating. Gastrointestinal bleeding has been documented, and colonoscopy is planned. The patient relates that he has had a blood transfusion at least one time in the past, in conjunction with orthopedic surgery performed on his ankle. Neither of his parents, nor any of his three sisters, are known to have had a significant bleeding disorder. At the time of his visit, the patient stated that he had refrained from taking any medications for the past week. In response to a series of follow-up questions, he specifically denied having taken aspirin, other nonsteroidal anti-inflammatory agents, or any of a series of agents known to have antiplatelet activity.
Association of Candida esophagitis with acute esophageal necrosis
Published in Baylor University Medical Center Proceedings, 2022
Muhammad Sheharyar Warraich, Bashar Attar, Shazaq Khalid, Muhammad Ali Khaqan
AEN is exceedingly rare, with an incidence of 0.01% to 0.28%.3 It was first described in 1914 by Brekke et al but did not get its current name until 1990.2,4 Some commonly described risk factors associated with this condition include renal insufficiency, diabetes mellitus, hypertension, atherosclerotic vascular disease, sepsis, and hypothermia.5 Mucosal barrier dysfunction seems to be the common endpoint of the different theories that have attempted to explain the pathogenesis of AEN. AEN typically occurs in critically ill patients who have multiple chronic conditions. It usually presents with upper gastrointestinal bleeding, but patients may display other symptoms like nausea, vomiting, dysphagia, and abdominal pain. Diagnosis is made on direct visualization during esophagogastroduodenoscopy. Biopsy is associated with a small risk of perforation and is supportive but not required for the diagnosis. It can help rule out infections and some other similar-appearing conditions like melanosis, melanoma, and acanthosis nigricans. Treatment is mostly supportive and includes aggressive hydration, proton pump inhibitors, and antimicrobials for cases that have a histologically confirmed infection. Total parenteral nutrition is a consideration for such patients due to the risk of perforation associated with the use of enteral tubes. Surgical management is necessary for the subset of patients whose disease is complicated by perforation or mediastinal disease. AEN is known to have a high mortality rate, with one study suggesting a rate up to 28%.6
Prevention of recurrent thromboembolism in myeloproliferative neoplasms: review of literature and focus on direct oral anticoagulants
Published in Postgraduate Medicine, 2021
Joan How, Charlotte Story, Jean Marie Connors
Independent of the use of aspirin, MPN patients also have increased bleeding risk, with bleeding complications reported in 6% of MPN patients in one meta-analysis[25]. Bleeding complications are usually not major, with the majority of events consisting of mucosal, cutaneous, or gastrointestinal bleeding. However, in patients with Budd-Chiari syndrome, clinically significant bleeding is an important consideration given the development of varices from portal hypertension. Bleeding risk factors are not as well described compared to thrombotic risk factors, and have included thrombocytosis and leukocytosis across studies [36,63]. Driver mutation allele status has not been definitively shown to predict bleeding[64]. The mechanism of bleeding in MPNs is multifactorial, and likely related to qualitative defects in hematopoietic cells. Extreme thrombocytosis results in paradoxical bleeding rather than thrombosis, which in some cases may be due to an acquired von Willebrand syndrome, in which large von Willebrand multimers are sheared by increased platelet numbers[65]. However, the development of acquired von Willebrand corresponds poorly to any specific platelet threshold[66].
Patients with acute myocardial infarction and atrial fibrillation: association of anaemia with risk of in-hospital bleeding, stroke and other death causes
Published in Biomarkers, 2021
Shi-Dong Guo, Ying Bai, Xin-Yao Liu, Yue Liu, Zhen-Zhou Wang, Peng Zhong
In the current study, no association was found between anaemia and major bleeding, different from a previous study (Dauerman et al.2005). However, anaemia would increase the risk of minor bleeding, especially gastrointestinal bleeding in the in-hospital patients with AMI and AF, consistent with the study of Kikkert et al. (2015). Their study found that anaemia was associated with increased gastrointestinal bleeding risk in the patients with STEMI during long-term follow-up. The inconsistent risk of any bleeding, major bleeding and minor bleeding caused by anaemia in these patients surprised us. The possible reason was concluded as follows after reviewing the case reports. Dual anti-platelet drugs for AMI treatment would increase the risk of bleeding, such as cerebral haemorrhage, ophthalmorrhagia, and gastrointestinal bleeding. Gastrointestinal bleeding was the main reason among these bleeding risks (accounting for 81.5%). Proton pump inhibitors (PPIs) or gastric mucosal protective agents were very effective in preventing gastrointestinal bleeding. Therefore, the widely use of PPIs or gastric mucosal protective agents was very helpful in preventing minor gastrointestinal bleeding from developing into major bleeding.