Blessing for the Bleeder: Bevacizumab in Hereditary Hemorrhagic Telangiectasia

  1. William Hocking, MD, FACP
  1. *Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
  2. Department of Hematology-Oncology, Marshfield Clinic, Marshfield, Wisconsin, USA
  1. Corresponding Author: Narendranath Epperla, MD, Department of Hematology-Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, Tel: (414) 805-4600, Email: nepperla{at}mcw.edu

Abstract

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by uncontrolled multisystem angiogenesis with epistaxis, gastrointestinal bleeding, iron-deficiency anemia, and arteriovenous malformations, and is often associated with increased levels of vascular endothelial growth factor (VEGF). Bevacizumab, a VEGF inhibitor, reduces epistaxis, telangiectasias, and iron-deficiency anemia. We present the case of a woman with HHT and chronic gastrointestinal bleeding who required iron supplementation and multiple blood transfusions. Bevacizumab resulted in marked symptom improvement and transfusion-independence. Our report describes the dose schedule and calls for a randomized, controlled trial demonstrating the value of bevacizumab therapy.

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