Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

Abstract

Background: Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS). This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group.

Methods: We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias.

Results: No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels.

Conclusion: These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.

Figure 1

Angioectasia in the jejunum detected by capsule enteroscopy. Patient from the study group.

Figure 2

Western blot shows a slightly depleted level of large von Willebrand multimers in one of the study patients (right) and a patient with normal levels (left).