Ferric carboxymaltose reduces the number of red blood cell units transfused and allows transfusion independence to be obtained in patients with iron deficiency anemia secondary to gastrointestinal chronic blood loss.

BACKGROUND: The aim of this study was to evaluate the effectiveness of ferric carboxymaltose (FCM) in patients with iron deficiency anemia (IDA) secondary to gastrointestinal chronic blood loss (CBL), who received chronic transfusion support. STUDY DESIGN AND METHODS: We retrospectively evaluated 38 patients with IDA (hemoglobin [Hb] < 10 g/dL and ferritin < 12 ng/mL or transferrin saturation [TSAT] < 16%) refractory or intolerant to oral iron therapy that necessitated transfusion support in the previous 12 months. They were treated with FCM (500-2500 mg). The primary endpoint was to evaluate the reduction of transfusion requirements (red blood cell [RBC] units) after FCM treatment. RESULTS: The median age of the cohort was 78 years, with a male:female ratio of 22:16. Before FCM treatment a median of 6 RBC units had been transfused. At the treatment (T0) the median value of Hb was 8.7 g/dL, the TSAT 6%, and ferritin 12 ng/mL. The median FCM dose was 1000 mg. At 5 weeks from T0 the median Hb level was 11 g/dL, with a median increase of 2.4 g/dL. With a median follow-up of 326 days, the median transfusion requirement was 0 RBC units, significantly lower than before T0 (p < 0.001). Overall 17 patients still necessitated transfusion support. Twenty-three patients needed retreatment with FCM for recurrence of IDA: 10 of them obtained a response again. The percentage of transfusion-independent patients at median follow-up was equal to 52%. CONCLUSION: In patients with IDA secondary to CBL, FCM significantly reduces the need of transfusions and achieves transfusion independence in half of the cases.

Perioperative ROTEM and ROTEMplatelet monitoring in a case of Glanzmann's thrombasthenia.

Glanzmann's thrombasthenia is a rare, inherited disease, which consists in abnormality of the glycoprotein IIa/IIIb genes that causes impaired platelet function. Glanzmann's thrombasthenia patients show prolongation of bleeding time and may experience life-threatening hemorrhage after surgery. We present a case of a young woman having Glanzmann's thrombasthenia, who underwent gynecological operation for ovarian cyst. Perioperative monitoring included thromboelastometry with ROTEM and impedance aggregometry with ROTEMplatelet. In this case, despite acceptable ROTEM results after platelet transfusion, ROTEMplatelet was more indicative of hemostatic impairment and reflected the bleeding occurred in the postoperative period. When treating patients with congenital or acquired platelet dysfunction, some intrinsic limits of thromboelastometry to assess platelet function may be overcome with the combined use of a point-of-care device that measures platelet aggregation.

Laser therapy and surgical treatment in transfusion-dependent patients with upper-gastrointestinal vascular ectasia.

We report the results of endoscopic laser therapy on 59 patients with upper gastrointestinal vascular ectasia. After 300 sessions, complications were two nonbleeding and three bleeding ulcers, treated successfully with endoscopic therapy. After treatment, blood transfusions were abolished in 61% and reduced in 22% of the patients, whereas 17% of the patients were nonresponders and 5% died for bleeding. Treatment outcome correlated with endoscopic healing, number of yearly transfusions, and lesions' localization. Patients, who did not respond to laser therapy by the sixth session, showed no improvement afterwards. Four patients with persistence of bleeding despite laser therapy underwent surgery and in three of them, a long-term control of bleeding was obtained. In conclusion, laser therapy was safe and effective; nonetheless, surgical treatment should be considered, after adequate staging, for those patients receiving more than 10 blood units per year or who have undergone more than six laser sessions without improvement.