Present a patient with persistent intestinal bleeding due to enterocolitis associated
Present a patient with persistent intestinal bleeding due to enterocolitis associated with cytomegalovirus infection and acute graft-versus-host-disease (GvHD). The 45-year old, Caucasian male had chronic myelogenous leukemia (CML) which had been diagnosed 2 years earlier. The CML was in its first chronic phase, it was bcr/abl PCR positive, and had shown only minimal cytogenetic response to conventional treatment with high-dose hydroxycarbamide and interferon alpha. Therefore, he received allogeneic peripheral blood stem cell transplantation from an unrelated HLA-identical donor after conditioning with busulfan and high-dose cyclophosphamide. The leukocyte nadir was on day +5. Graft take was apparent on day +9 after transplantation, with total leukocytes recovering to over 1 G/L. Prophylaxis for GvHD consisted of ciclosporin A, methotrexate, and a short course of lowdose rabbit antithymocyte globulin. In spite of these intensive efforts, acute GvHD of the skin (grade III) developed on day +8, as shown by skin biopsy. Cytomegalovirus infection was diagnosed on day +21 (pp65 was found in 13 of 200,000 leukocytes), and treated with ganciclovir and foscarnet. Acute respiratory failure required respiratory support. The patient was intubated and transferred to the intensive care unit on day +20.Page 2 of(page number not for citation purposes)Thrombosis Journal 2006, 4:http://www.thrombosisjournal.com/content/4/1/Despite massive transfusions and maximal intensive care, the patient rapidly progressed to multiorgan failure with progression of bilateral pulmonary infiltrates (“white lungs”), anuria, severe acidosis, and vasopressor-refractory hypotension. The patient died one day after start of the second HIV-1 integrase inhibitor 2 supplier rFVIIa treatment series, on day +34 after transplantation.DiscussionrFVIIa was developed for the treatment of hemorrhagic episodes in haemophilic patients with inhibitors to factors VIII and PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/25636517 IX. Since its introduction, it has also been used “off-label” to enhance haemostasis in non-haemophilic patients who experience bleeding episodes unresponsive to conventional therapy. Conclusive evidence of its effectiveness in non-haemophilic conditions from controlled clinical trials is not yet available [6,7]. “Last-ditch” use of rFVIIa in patients with massive haemorrhage resistant to conventional treatment did not rescue these patients or significantly alter outcomes in a retrospective study by Clark et al [8]. None of the published randomized, placebo-controlled, double-blind clinical trials of rFVIIa in non-haemophilic patients with severe bleeding found significant differences in clinical outcomes. Prophylactic rFVIIa dosing did neither significantly reduce the number of blood products transfused after major partial hepatectomy [9], nor did it decease the perioperative blood loss in reconstruction surgery for traumatic fracture of pelvis and acetabulum [10]. Furthermore, there was no significant differences in mortality in patients with cirrhosis and upper gastrointestinal bleeding when treated with rFVIIa or placebo [11]. Results from these prospective randomized placebo-controlled trials on the use of rFVIIa as an adjunct for prevention and therapy of bleeding in surgery and liver diseases recommended, thus, conventional intervention for prevention and control of haemorrhage in non-haemophilic patients and contrast thereby to other more optimistic studies [3-5]. Severe bleeding refractory to standard support is also common in patients undergoing b.
