Bevacizumab
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Lower intestinal tract haemorrhage leading to haemorrhagic shock: case report An 81-year-old man developed lower intestinal tract haemorrhage leading to haemorrhagic shock while receiving bevacizumab for a local recurrence of superior rectal cancer. The man began receiving bevacizumab 7.5 mg/kg on day 1 every 3 weeks [route not stated] in addition to other chemotherapy. Twenty seven days after the initiation of bevacizumab, he experienced a large volume of bloody bowel discharge from the mucous fistula and anus. At outpatient investigation, his temperature was 34.7°C, BP was 60/25 mmHg, and his pulse was weak. His whole body was stiff, he was in a state of agitation and did not respond to calling. Haematological tests revealed the following: RBC 278 ×104/mm3, haemoglobin 9.4 g/dL, and haematocrit 27.3%. Mild hypoproteinuria and kidney dysfunction were also noted (albumin 2.7 g/dL and creatinine 1.13 mg/dL), in addition to a mild coagulation disorder (Prothrombin Time-INR 1.13). He was diagnosed with lower digestive tract haemorrhage accompanied by haemorrhagic shock. Rapid fluid therapy alleviated the state of shock, and the man was admitted to hospital. Colonoscopy revealed a depressive lesion to which blood clots were adhered; this area was closed with a clip. Symptoms of shock reappeared, and a large volume of bloody bowel discharge was observed twice. Rapid transfusion was performed, and his overall systemic condition was maintained. Angiography identified the haemorrhaging region, and selective coil embolisation was conducted. Following this, there was no reccurrence of haemorrhage, and his overall condition improved. The man continued chemotherapy without bevacizumab on an outpatient basis. Author comment: As haemorrhaging was observed from areas where there were no clear findings such as mucosal abnormalities, it was most strongly suspected that it was digestive tract haemorrhaging due to bevacizumab. Tsuchida K, et al. A case of rectal hemorrhage during chemotherapy with bevacizumab for local recurrence of rectal cancer. Gan to Kagaku Ryoho 39: 675-677, No. 4, Apr 2012 [Japanese; summarised from a translation] 803076403 Japan
0114-9954/10/1417-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 1 Sep 2012 No. 1417
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