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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
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Mesenteric infarction due to iatrogenic polycythemia.
Katrina Skoog1, Marie Carmelle-Elie1, Kevin Ferguson1
1University of Florida School of Medicine, Gainesville, FL, USA.
World Journal of Emergency Medicine
|September 13, 2014
Summary
Iatrogenic polycythemia from unmonitored erythropoiesis-stimulating agents like Procrit can cause mesenteric infarction. Close hematocrit monitoring is crucial to prevent severe complications such as this rare gastrointestinal event.
Area of Science:
- Hematology
- Oncology
- Gastroenterology
Background:
- Polycythemia vera is a myeloproliferative disorder with elevated red blood cells.
- Iatrogenic polycythemia, induced by medications, has not been previously linked to mesenteric thrombosis.
- Erythropoiesis-stimulating agents (ESAs) are used to treat anemia in cancer patients.
Observation:
- A patient with non-small cell lung cancer on maintenance chemotherapy (Tarceva) and Procrit developed an acute abdomen.
- The patient experienced ischemic bowel and mesenteric infarction due to unmonitored Procrit use leading to hyperviscosity.
- Despite normal white blood cell and creatinine, the patient required ventilator support and tube feeding.
Findings:
- The patient's condition was attributed to unmonitored Procrit-induced hyperviscosity and mesenteric infarction.
- Procrit and chemotherapy were discontinued due to the adverse event.
- The patient was transferred to a subacute care facility for ongoing management.
Implications:
- Erythropoiesis-stimulating agents (e.g., epoetin) carry risks including cardiovascular events, bleeding, and thromboembolism.
- This case highlights the potential for ESAs to cause mesenteric infarction if hematocrit levels are not closely monitored.
- Careful monitoring of hematocrit is essential when administering ESAs to prevent serious complications.
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