Coeliac disease presenting as acute bleeding disorders.
نویسندگان
چکیده
Case I A previously well, 27-year-old woman was admitted to an acute haematology unit with multiple severe bruising. For 3 months before admission she had been having vague colicky abdominal pain with pale, bulky, offensive stools which were difficult to flush away. She had lost 9 5 kg in weight. Two weeks before admission she had developed spontaneous bruising of her limbs. She had no melaena or haematuria. She was unemployed, a non-smoker, and she drank three pints of beer nightly. She had a normal diet and was on no drugs. Examination showed her to be pale with multiple old and fresh bruises as well as large haematomas on her legs. There were no cutaneous stigmata of liver disease. The abdomen was slightly distended and rectal examination showed pale stools only. Examination was otherwise normal. Investigations showed Hb 9-5 g/dl; WCC 7-6 x 109/1; platelets 510 x 109/l; MCV 90 fl; MCH 30 3 pg; MCHC 320 g/dl; reticulocytes 5%; iron 6 ,umol/l; (normal 10-30), serum albumin 25 g/l; calcium 2-3 mmol/l; (normal 2-18-2-62); B12 320 ng/l (normal >260); folate 1 7 ,ug/l (normal >3); prothrombin time 120 sec (control 12); kaolincephalin clotting time (KCCT) 120 s (control 42). Clotting factors II, VII and X were all present in reduced concentration. Sigmoidoscopy was normal. Barium follow-through findings showed disease of the jejunum with a malabsorptive pattern. The patient was treated with fresh frozen plasma and vitamin K intravenously and oral iron and folate supplements. Her prothrombin time returned to normal immediately and she showed a good reticulocyte response. She was allowed home awaiting a jejunal biopsy as an out-patient. However, soon after discharge she was admitted with tetany due to hypocalaemia, and was treated with intravenous calcium. A jejunal biopsy was performed, which showed sub-total villous atrophy, strongly in favour of coeliac disease. She was started on a gluten-free diet and was well some three months later with a normal bowel habit and haematological indices. Repeat biopsy was arranged but the patient has since left the area.
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عنوان ژورنال:
- Postgraduate medical journal
دوره 58 677 شماره
صفحات -
تاریخ انتشار 1982