Silent angiodysplasia and occult haemobilia as rare but treatable causes of refractory iron deficiency - Two case reports

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dc.contributor.authorJacobs P.
dc.contributor.authorWood L.
dc.contributor.authorBaker P.
dc.contributor.authorEllmann A.
dc.contributor.authorPayne M.
dc.date.accessioned2011-05-15T16:16:31Z
dc.date.available2011-05-15T16:16:31Z
dc.date.issued2005
dc.description.abstractOnce menorrhagia has been excluded in females then, in both sexes, the gastrointestinal tract remains the commonest site for haemorrhage. This may be of surprisingly large volume but intermittent and therefore not universally demonstrated on stool testing. However, if loss is persistent it may nevertheless culminate in absolute iron deficiency and thus, even when occult blood is not present on repeated examinations, quantitation using chromium labelled red cells becomes invaluable. In this situation, endoscopy or contrast radiology of the small and large bowel may fail to reveal any lesion even when these procedures are repeated or used in combination. Modifications by direct inspection or camera study may be helpful in improving diagnostic accuracy. It is nevertheless practical, as illustrated by these two cases, to more widely recognise the value of radionuclide scanning methods. In one this was due to unsuspected haemobilia and the second to major duodenal vascular malformation although it could be reasonably argued that initial recourse to angiography might have demonstrated this. The principle is that when precisely defined anatomically surgery can be elective and limited as a result of careful proactive planning and operations likely to have a high initial rate of success. The role of nuclear medicine in the investigative algorithm of such patient is re-emphasised. Thus, in any individual with unexplained but proven absolute iron deficiency failure to reveal the cause by first screening with gastroscopy and colonoscopy or barium studies including the small bowel should not automatically be repeated. Rather, the blood loss needs to be documented and, if possible, subsequent evaluation moved to advancement or push enteroscopy, capsule endoscopy or the more invasive angiography only once quantity a pattern of bleeding are defined by radioisoptic imaging. © 2005 Taylor & Francis.
dc.description.versionArticle
dc.identifier.citationHematology
dc.identifier.citation10
dc.identifier.citation6
dc.identifier.issn10245332
dc.identifier.other10.1080/10245330500233957
dc.identifier.urihttp://hdl.handle.net/10019.1/13816
dc.subjectferritin
dc.subjecthemoglobin
dc.subjectiron
dc.subjecttransferrin
dc.subjectadult
dc.subjectangiodysplasia
dc.subjectangiography
dc.subjectarticle
dc.subjectcase report
dc.subjectcolonoscopy
dc.subjectdiagnostic test
dc.subjectgastroscopy
dc.subjecthemoglobin determination
dc.subjecthemophilia
dc.subjecthuman
dc.subjectiron blood level
dc.subjectiron deficiency anemia
dc.subjectlaboratory diagnosis
dc.subjectmale
dc.subjectpriority journal
dc.subjectrefractory anemia
dc.subjectthrombocyte count
dc.subjectAdult
dc.subjectAnemia, Iron-Deficiency
dc.subjectAngiodysplasia
dc.subjectHemobilia
dc.subjectHumans
dc.subjectMale
dc.titleSilent angiodysplasia and occult haemobilia as rare but treatable causes of refractory iron deficiency - Two case reports
dc.typeArticle
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