Veronica Zaharia-Czeizler, MD
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Zaharia-Czeizler V. Erythropoietin Stops Chronic Diffuse Transfusion-Dependent Gastrointestinal Bleeding. Ann Intern Med. 2001;135:933. doi: 10.7326/0003-4819-135-10-200111200-00028
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Published: Ann Intern Med. 2001;135(10):933.
TO THE EDITOR:
Erythropoietin is currently indicated for anemia in patients with chronic renal failure, anemia in patients with cancer, and HIV-positive patients. This report suggests that erythropoietin can stop recurrent, transfusion-dependent bleeding from diffuse lesions of the gastrointestinal tract that have not responded to attempts at local hemostasis.
After administration of erythropoietin-α (Procrit, Amgen, Inc., Thousand Oaks, California), four patients became transfusion independent and had improved quality of life.
Two patients (patients 1 and 4) bled because of angiodysplasia of the colon. Other causes of bleeding were radiation proctitis in patient 2 and end-stage rectal adenocarcinoma in patient 3. All patients had chronic anemia and were transfusion dependent. A higher erythropoietin dose was administered subcutaneously during the 1st week (mean, 226.5 U/kg per week) than during subsequent weeks (mean, 117 U/kg per week). In all patients, the clinical signs of bleeding stopped, results on fecal occult blood testing became negative, and the hemoglobin level increased. Patient 1 received erythropoietin at regular intervals; his hemoglobin level increased and then remained stable at 117 mg/L for the following 3 years. For the other three patients, erythropoietin was not administered regularly. During times of bleeding, regular erythropoietin injections controlled bleeding and increased the hemoglobin level. When erythropoietin treatment was discontinued, bleeding recurred and the hemoglobin level decreased. Upon restarting erythropoietin treatment, bleeding stopped and the hemoglobin level increased again. No side effects of erythropoietin occurred. Duration of clinical monitoring and treatment was as follows: patient 1, 3 years; patient 2, 4.5 years; patient 3, 6 months; and patient 4, 4 years.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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