Abstract: PUB041
Transfusion-Dependent Angiodysplasia-Related Anemia in a Patient with ESRD Treated with Thalidomide
Session Information
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Kulkarni, Mugdha, UC Health, Cincinnati, Ohio, United States
- Kaur, Taranpreet, Cincinnati VA Medical Center, Cincinnati, Ohio, United States
Introduction
Incidence of gastrointestinal (GI) arteriovenous malformations (AVMs) also called angiodysplasia in patients with end-stage renal disease (ESRD) is notably higher compared to general population.
According to a study by Ohmori et al., vascular lesions were observed in 61.5% of hemodialysis (HD) patients with obscure GI bleeding. We present a complex case of an ESRD on HD veteran with extensive GI tract angiodysplasia, pancytopenia needing yearlong thalidomide to prevent recurrent bleeding.
Case Description
65year old male with ESRD on HD, Diabetes mellites(DM), Hypertension transferred his care to HD unit at the VA Medical Center, Cincinnati in April 2023. He had multiple hospitalizations for GI bleed, anemia from intestinal AVM, Gastric antral vascular ectasia diagnosed in 2020 needing argon laser photocoagulation and 5 endoscopic interventions. A Bone marrow biopsy (2021) for pancytopenia showed red cell dysplasia, atypical ring sideroblasts and atypical megakaryocytes raising suspicion for MDS. Despite optimal dose of epogen analogues, iron infusions and octreotide infusions he needed weekly blood transfusions. Hematology started him on thalidomide at 100mg daily for 28days every month from 10/2023 to 1/2024 with marked improvement in his Hemoglobin. Due to lack of long term safety data, he was taken off thalidomide after 4 months causing worsening anemia. We decided to restart same dose of thalidomide June 2024 as benefits overweighed the risk after discussion with the patient. He is on epogen analogue with HD and has not required a blood transfusion since.
Discussion
In ESRD patients vascular proliferation from mucosal hypoxia, DM, peripheral vascular disease, uremic platelet dysfunction, anticoagulation and phosphate binders like sevelamer can promote angiodysplasias.Guidelines suggest somatostatin analogues or thalidomide in case of bleeding despite endoscopic therapy.
Chen et al. evaluated 4 month treatment with thalidomide for recurrent bleeding due to AVM. The study excluded ESRD patients. This unique case with florid GI AVM, pancytopenia required a tailored approach of yearlong thalidomide. Patient did not have side effects like somnolence or constipation despite the duration.