| [ Summary ] |
Gastrointestinal bleeding observed in patients with bleeding tendency is often multifocal and difficult to control, resulting in the necessity of open surgery or endoscopic treatment to stop bleeding by clipping bleeding vessels, local injection of hypertonic saline or ethanol.Bleeding control may also be achieved through the use of heated probes, as well as microwave or argon plasma coagulation, and local attachment of epinephrine or thrombin. Preceding endoscopic study or treatment, differential diagnosis and evaluation of severity of bleeding tendencies are both mandatory. Examination of platelet counts, prothrombin time (PT), and activated partial thromboplastin time (APTT) may be adequate for the initial screening study. In addition, FDP and bleeding time should be checked in cases where there is suspicion of DIC and platelet functional defects, respectively. To prevent excess bleeding, administration of tranexamic acid is useful. Transfusion of platelet concentrates is necessary in thrombocytopenic patients to maintain platelet counts of 3x104/μl for endoscopic / observation only and 5×104/μl for treatment hemostasis. For coagulation defects, the activity of each coagulation factor should be raised to 20-30% of the normal values by infusion of specific coagulation factor concentrates or fresh frozen plasma to maintain PT/INRs of 2.0 and APTTs in double the normal upper limits. |