Jiang Qian, Huang Xiao-jun, Chen Huan, Xu Lan-ping, Liu Dai-hong, Chen Yu-hong, Zhang Yao-chen, Liu Kai-yan, Guo Nai-lan, Lu Dao-pei
Institute of Hematology, Peking University, People's Hospital, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2005 May;26(5):277-80.
To analyze the features, causes, treatments and outcomes of severe gastrointestinal (GI) bleeding after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Fifteen patients suffered from massive GI bleeding (blood loss leading to hemorrhagic shock) or subacute GI bleeding (at least 1 or more units of red blood cell transfusion on each of two consecutive days) were observed and analyzed after allo-HSCT.
Seventeen severe GI bleeding episodes occurred in 15 patients. The severe bleeding occurred in three periods of time: within 1 week, 1 to 2 months and 4 to 7 months after transplantation. The main manifestation was hematemesis and hematochezia in the first period, and hematochezia alone in the second and third periods. Platelet counts at the onset of severe bleeding were < or = 50 x 10(9)/L in the majority of patients. Causes of bleeding were conditioning regimen-related toxicity in 2 patients/episodes, graft versus host disease (GVHD) or/and intestinal cytomegalovirus (CMV) or fungal infections in 11 patients/12 episodes, intestinal CMV infections in 1 patient/episode, acid-peptic ulcer in 2 patients/episodes, and cause unknown in 1 patient/episode. Supportive care such as transfusions of platelet, red blood cell and fresh frozen plasma, H2 receptor blockers and omeprazole were given to all patients, immunosuppressive drugs to patients developed GVHD and antiviral drugs to patients with complicated CMV infection. Eight patients/9 episodes of bleeding were controlled. Eight patients continued severe GI bleeding and died of acute GVHD or related serious complications.
Severe GI bleeding after allo-HSCT are mainly caused by regimen-related toxicity, GVHD or/and intestinal CMV infection. Bleeding caused by conditioning regimen-related toxicity is self-limited and has a better prognosis. However, treatment failure and mortality are high if the patient's bleeding resulted from GVHD and intestinal CMV infection.
分析异基因造血干细胞移植（allo-HSCT）后严重胃肠道（GI）出血的特征、原因、治疗方法及结局。
观察并分析15例异基因造血干细胞移植后发生大量胃肠道出血（失血导致失血性休克）或亚急性胃肠道出血（连续两天每天至少输注1个或更多单位红细胞）的患者。
15例患者共发生17次严重胃肠道出血事件。严重出血发生在三个时间段：移植后1周内、1至2个月以及4至7个月。第一阶段主要表现为呕血和便血，第二和第三阶段仅表现为便血。大多数患者严重出血发作时血小板计数≤50×10⁹/L。出血原因包括2例/次与预处理方案相关的毒性反应，11例/12次移植物抗宿主病（GVHD）或/和肠道巨细胞病毒（CMV）或真菌感染，1例/次肠道CMV感染，2例/次酸相关性溃疡，1例/次原因不明。所有患者均给予输注血小板、红细胞和新鲜冰冻血浆、H2受体阻滞剂和奥美拉唑等支持治疗，发生GVHD的患者给予免疫抑制药物，合并CMV感染的患者给予抗病毒药物。8例患者/9次出血得到控制。8例患者持续严重胃肠道出血，死于急性GVHD或相关严重并发症。
allo-HSCT后严重胃肠道出血主要由预处理方案相关毒性、GVHD或/和肠道CMV感染引起。由预处理方案相关毒性引起的出血具有自限性，预后较好。然而，如果患者的出血是由GVHD和肠道CMV感染导致，则治疗失败率和死亡率较高。
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