A 68-year-old patient who suffered Fourniers gangrene in 2004 required transient hyperbaric seizure.
In April 2006, he was admitted to hemodialysis (HDC) for diabetic nephropathy.
She had a history of diabetes mellitus, hypertension, urinary lithiasis, peptic ulcer, coronary and peripheral ulcer (coronary artery stenosis/bifemoral aorto in 2002), chronic liver damage and pulmonary embolism.
In 2006, the patient was hospitalized twice due to high HD because of an active ulcer. The patient was treated with a local injection of duodenal secretions and clots on the other occasion.
She received 10 units of red blood cells (RBC).
In the following year (2007) he was hospitalized twice for low HD without finding lesions in upper endoscopy and endoscopy.
The video camera showed angiodysplasias in the middle small intestine and duodenum.
The latter were treated with argon-plasma.
The patient remained persistently anemic (mean hemoglobin 7.7 g/dL on routine monthly tests) despite the use of erythropoietin (EPO) 12,000 units/week, ev400 mg of folic acid per month.
In 2008, she was hospitalized twice for HD and maintained persistent digestive bleeding.
In spite of being transfused 45 UGR (average monthly non-transferred saturation and administered EPO (12,000-24,000 weekly units), iron, vitamins B6 and B12 and folates 26% gAT
Due to a progressive increase in the mean corpuscular volume with high folate and B12 levels, a myelogram showed signs of myelodysplasia.
A scanner showed a 14.5 cm long rod that led to suspicion of hyperstimulation.
The year 2009 continued with low frequent bleeding and anemia worsened with a mean hemoglobin of 6.3 g/dL despite receiving weekly beta-blocker 12,000 U (posteriorly 200 g/dL red blood cells) monthly (propole-14 units).
TAS always remained < 17%.
In 2010, anemia increased despite increasing the dose of EPO receptor activator to 400 μg /months, requiring 15 UGR in the first 2 months without exceeding a hematocrit.
Placement of TAL was decided on due to its antiangiogenic effects, with patient authorization, indicating 1⁄2 tablet daily (50 mg) on February 25, 2010.
In March the patient did not require transfusions, stopped bleeding externally and hematocrit increased to 21.6%.
On March 29, the arteriovenous fistula was thrombosed and the drug was suspended.
In the following days the digestive bleeding reappeared, the hematocrit dropped to 16% requiring 6 UGR.
TAL 100 mg/day was restarted on April 20.
In the following 2 months she did not require transfusions or external bleeding and her hemoglobin level rose to 10.6 g/dL.
Later, he died as consequences of an encephalocraneal trauma by fall in the bathroom.
