The significance and work-up of minor gastrointestinal bleeding in hospitalized nursing home patients.

Twenty-seven consecutive admissions from nursing homes who underwent a gastrointestinal (GI) consult for coffee ground vomitus or occult GI bleeding to evaluate the outcome were reviewed retrospectively to determine whether a GI work-up was or would have been useful. There were 15 deaths, all associated with severe infection or respiratory failure. Endoscopy, barium studies, and a history of nonsteroidal anti-inflammatory drug use or peptic ulcer disease did not affect the management or outcome. No patient developed major GI bleeding. When nursing home patients present with coffee ground vomitus or newly found occult blood in the stool, efforts should be made to identify and vigorously treat any acute underlying infection or respiratory failure. Endoscopy is not helpful in this clinical situation. Both the primary care physician and the GI consultant should be aware of these associations and should focus on the underlying etiology.

Chronic hepatitis C in patients with sickle cell disease.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) antibody in patients with sickle cell disease and to analyze the nature of chronic liver disease in these patients. METHODS: A total of 99 patients attending a comprehensive sickle cell and thalassemia program at the Interfaith Medical Center, Brooklyn, NY, participated in the study. Eighty-five patients had sickle cell anemia (ss), eight had sickle C disease (sc), and six had sickle B thalassemia. History of blood transfusion, i.v. drug use, homosexuality, and alcohol abuse was obtained with a questionnaire and chart review. All patients were screened for HCV antibody by a first generation enzyme-linked immunosorbent assay. All positive results were confirmed with radioimmunoblot assay II (RIBA II). Patients were also checked for the presence of hepatitis B surface antigen. ALT levels were measured, and percutaneous liver biopsies were performed in patients positive for HCV antibody and greater than 1.5 times the normal ALT levels. RESULTS: Antibody to HCV was detected in 10/99 patients (10.10%). Seven of 30 patients (23.33%) who received more than 10 U of packed red blood cells were positive for HCV antibody. Only 3/38 (7.9%) patients with less than 10 U of packed red blood cells in the past were positive for HCV antibody. None of the patients who never received blood transfusion were positive for HCV antibody (0/31 or 0%). A total of seven liver biopsies were performed in patients positive for HCV antibody. Two out of seven specimens (28.57%) showed significant liver damage. One revealed cirrhosis, and the other showed chronic active hepatitis. The remainder of liver biopsies (5/7; 71.42%) showed only mild portal inflammation. CONCLUSIONS: The prevalence of HCV antibody is directly related to the number of blood transfusions in patients with sickle cell disease. Chronic HCV infection could be a major cause of cirrhosis of the liver in these patients.