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Severe delayed postpolypectomy bleeding in elder patient with post-polycythemia myelofibrosis.
BMC Surgery
|November 26, 2013
Summary
Patients with post-polycythemia myelofibrosis may face delayed bleeding after endoscopic polypectomy. This case highlights the need for extended monitoring beyond one week for myeloproliferative neoplasms patients undergoing endoscopic procedures.
Area of Science:
- Gastroenterology
- Hematology
- Oncology
Background:
- Discusses medical management and monitoring of patients with myeloproliferative disorders.
- Highlights risks associated with minimally invasive surgery in this patient population.
Observation:
- A 75-year-old woman with post-polycythemia myelofibrosis experienced delayed major bleeding post-endoscopic polypectomy.
- The patient had a high platelet count (837 × 10^9/L) and was on antiplatelet therapy, withdrawn 7 days prior and resumed 1 week after the procedure.
- The resected polyp measured 11 x 19 mm on the right colon.
Findings:
- Myeloproliferative neoplasms (MPNs) represent a significant risk factor for complications during endoscopic polypectomy.
- Delayed hemorrhage occurred despite adherence to standard antiplatelet drug management protocols.
Implications:
- Current guidelines may not apply to all patients with MPNs undergoing endoscopic procedures.
- Extended patient monitoring is crucial for at least one week post-procedure, even with antiplatelet therapy, to mitigate risks of delayed bleeding.
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