181

INCIDENCE, CLINICAL PATTERNS AND OUTCOMES OF GASTROINTESTINAL BLEEDING IN ADULT PATIENTS RECEIVING ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR ACUTE LEUKEMIA OR MYELODYSPLASTIC SYNDROME

M Puglia, J Marshall, N Heddle
McMaster University, Hamilton, Ontario

OBJECTIVES / METHODS: Descriptive, retrospective chart review to determine the incidence, clinical patterns and outcomes of gastrointestinal (GI) bleeding in adults with acute leukemia or myelodysplastic syndrome undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
RESULTS: GI bleeding was identified in 12/142 patients (8.4%, 7 female). Average age was 37 years. Bleeding manifestations included, melena (N=3), hematemesis/coffee-grounds (N=3), hematochezia (N=3) or a combination (N=3). Average onset of bleeding was day +45. Average hemoglobin drop was 20 g/L and average platelet count was 22x10⁹. Gastrointestinal graft versus host disease (GVHD) was noted in 7 patients prior to the onset of bleeding. Nine underwent esophagogastroduodenoscopy (EGD). Potential bleeding sources were found in the esophagus (6 patients; white exudate, esophagitis or erosion/ulceration), stomach (8 patients; gastritis, petechial hemorrhage, or erosion/ulceration) and duodenum (4 patients; duodenitis or adherent clot). Among 3 colonoscopies and 1 flexible sigmoidoscopy, all revealed significant colitis and 1 showed a sigmoid ulcer with visible vessel requiring cauterization. Biopsy pathology available for 8 patients was interpreted as GVHD (3 gastric, 4 colonic, 1 esophageal) and/or viral infection (2 esophageal, 1 gastric/ duodenal) or normal (1 patient). Two patients had ongoing, recurrent bleeding. One required subtotal colectomy for ischemic enterocolitis. GI bleeding was implicated in 2 deaths. Autopsies revealed hemorrhagic/necrotizing enterocolitis and diffuse GI hemorrhage, respectively.
CONCLUSIONS: GI bleeding is common in allogeneic HSCT patients and conveys significant mortality. GHVD, opportunistic infection and thrombocytopenia may play significant roles. Endoscopy is primarily diagnostic and rarely therapeutic. Future investigation will assess independent risk factors for GI bleeding and develop management protocols.

PREVIOUS NEXT