Hemostatic disorders can often complicate
transplantation procedures. Moreover, antihemmorhagic drugs may not efficiently control
bleeding that occurs in such cases. We report on a patient who underwent
kidney transplantation complicated by bone marrow aplasia and gastric
bleeding who was successfully treated with recombinant activated FVII (
Novoseven). In May 2005, a 53-year-old man affected by
chronic renal insufficiency underwent
kidney transplantation. At the beginning of June, laboratory tests showed progressive reduction in the blood cell count with
anemia,
granulocytopenia, and
thrombocytopenia related to the development of marrow insufficiency. We commenced transfusion
therapy and administered hematologic
growth factors. On June 3, 2005, the patient underwent
surgical procedure to repair the abdominal wall. Two days thereafter, the postsurgical period was complicated by an episode of
melena. The patient received additional treatment with packed red cells, platelets, and fresh-frozen plasma. The gastrointestinal
bleeding continued until June 9, 2005, when
therapy with recombinant activated FVII (
Novoseven) was commenced at an initial dose of 90 microgr/kg. The first bolus did not significantly reduce the blood loss; it was therefore administered as a successive bolus at the same dosage that was able to stop
bleeding. Endoscopic examination performed the day after showed the absence of the hemorrhagic lesion in the gastric mucosa. In the subsequent days, the need for transfusion was dramatically reduced with no episode of
bleeding. At the same time, the laboratory and clinical findings of marrow insufficiency disappeared. Our case report showed that the use of a global
antihemorrhagic factor, such as
Novoseven, can successfully control gastrointestinal
bleeding even in complicated patients despite failure of traditional antihemostatic
therapy.