Dr. Muhammad Kamran is the Consultant Gastroenterologist in Saifee Hospital and Assistant Professor in Baqai Medical University in Karachi who spoke about the Gastrointestinal bleeding in patients with bleeding disorders on
World Haemophilia Day 17th April 2019. Which is discussed below:
Introduction
Types of bleeding disorders:
- Haemophilia A (factor VIII deficiency)
- Haemophilia B (factor IX deficiency)
- von Willebrand disease
- Rare factor deficiencies including I, II, V, VII, X, XI, XII and XIII
- Platelet function disorder
- Gastrointestinal (GI) bleeding is a life-threatening complication in patients with bleeding disorders
- Occurs in upto 25% of haemophilia patients
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| Organs of digestive system |
Risk factor
Helicobacter pylori (H. pylori) infection:
- Prevalence is similar to general population
- Due to increased bleeding complications, H. pylori screening and therapy may be useful in patients with bleeding disorder
Angiodysplasia:
- Small vascular malformation of the gut
- Common cause of unexplained gastrointestinal bleeding and anemia
- Frequently associated with von Willebrand disease
Signs that you are having GI bleed
- Vomiting fresh (red) or old (coffee ground) blood
- Passing bloody or black, tar-like stools when you have a bowel movement
- Pain in your stomach area
- Feeling weak
- Looking pale
Few additional points regarding GI bleed presentation
- If a bowel movement is streaked with bright blood, the blood may be coming from piles (hemorrhoids) or polyps in the rectum
- Darker blood in the stool usually comes from higher up in the intestines or stomach
- Certain medicines (for instance, iron tablets) can make your stools dark. Always read the label to check for this side effect
- A tar-like stool can be caused by blood swallowed during a nose or mouth bleed
- A person with a bleeding disorder can have the same illnesses as other people, such as appendicitis, pancreatitis, or a peptic ulcer
Treatment of GI bleed
Haemophilia:
- Immediately raise the patient’s factor levels
- Maintain the factor level until hemorrhage has stopped and etiology is defined
- Hemoglobin levels should be regularly monitored
- Treat anemia or shock, as needed
- Treat origin of hemorrhage as indicated
- Tranexamic acid or EACA may be used as adjunctive therapy for patients with Factor VIII deficiency and those with Factor IX deficiency who are not being treated with prothrombin complex concentrates
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