Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro

Introducción: la telangiectasia hemorrágica hereditaria o enfermedad de Osler-Weber-Rendu es una entidad  autosómica  dominante rara, con una frecuencia que oscila entre 1 por cada 5000 habitantes a 1 por cada 1331 dependiendo de la población y localización geográfica. Se caracteriza clínicamente po...

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Autores:
Pinto Angarita, Jean
García del Risco, Fernando
Puello Ramos, Walter
Tipo de recurso:
Article of journal
Fecha de publicación:
2024
Institución:
Universidad de Cartagena
Repositorio:
Repositorio Universidad de Cartagena
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spa
OAI Identifier:
oai:repositorio.unicartagena.edu.co:11227/18745
Acceso en línea:
https://doi.org/10.32997/rcb-2024-3959
Palabra clave:
sangrado oscuro
anemia ferropénica
capsula endoscópica
telangiectasia hemorrágica hereditaria
Rendu Osler Weber
angioectasia
obscure bleeding
iron deficiency anemia
capsule endoscopy
angiodysplasia
hereditary hemorrhagic telangiectasia
Rendu Osler Weber
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openAccess
License
JEAN PINTO - 2024
id UCART2_bb2c82b74cec58bbcd91ae6a28419c14
oai_identifier_str oai:repositorio.unicartagena.edu.co:11227/18745
network_acronym_str UCART2
network_name_str Repositorio Universidad de Cartagena
repository_id_str
dc.title.spa.fl_str_mv Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
dc.title.translated.eng.fl_str_mv Hereditary hemorrhagic telangiectasia as a cause of severe iron deficiency anemia of obscure origin
title Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
spellingShingle Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
sangrado oscuro
anemia ferropénica
capsula endoscópica
telangiectasia hemorrágica hereditaria
Rendu Osler Weber
angioectasia
obscure bleeding
iron deficiency anemia
capsule endoscopy
angiodysplasia
hereditary hemorrhagic telangiectasia
Rendu Osler Weber
title_short Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
title_full Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
title_fullStr Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
title_full_unstemmed Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
title_sort Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuro
dc.creator.fl_str_mv Pinto Angarita, Jean
García del Risco, Fernando
Puello Ramos, Walter
dc.contributor.author.spa.fl_str_mv Pinto Angarita, Jean
García del Risco, Fernando
Puello Ramos, Walter
dc.subject.spa.fl_str_mv sangrado oscuro
anemia ferropénica
capsula endoscópica
telangiectasia hemorrágica hereditaria
Rendu Osler Weber
angioectasia
topic sangrado oscuro
anemia ferropénica
capsula endoscópica
telangiectasia hemorrágica hereditaria
Rendu Osler Weber
angioectasia
obscure bleeding
iron deficiency anemia
capsule endoscopy
angiodysplasia
hereditary hemorrhagic telangiectasia
Rendu Osler Weber
dc.subject.eng.fl_str_mv obscure bleeding
iron deficiency anemia
capsule endoscopy
angiodysplasia
hereditary hemorrhagic telangiectasia
Rendu Osler Weber
description Introducción: la telangiectasia hemorrágica hereditaria o enfermedad de Osler-Weber-Rendu es una entidad  autosómica  dominante rara, con una frecuencia que oscila entre 1 por cada 5000 habitantes a 1 por cada 1331 dependiendo de la población y localización geográfica. Se caracteriza clínicamente por telangiectasias, epistaxis a repetición, lesiones viscerales vasculares como angioectasias y MAVs (malformaciones arteriovenosas). El diagnóstico se sospecha con tres de los 4 criterios de Curazao y se confirma con estudios genéticos y complementarios. El tratamiento para las angioectasias es el Argón plasma  y para  la MAV tratamiento médico con bevacizumab, embolización o resección quirúrgica y en última instancia trasplante hepático. El pronóstico es favorable si las complicaciones son diagnosticadas y tratadas a tiempo. Caso clínico: se presenta el caso de una paciente de 51 años de edad que se presentó con astenia y adinamia en la que se documentó telangiectasias en lengua, labios y dedos y se llegó al diagnóstico de telangiectasia hemorrágica hereditaria luego de la confirmación de malformación arteriovenosa hepática y telangiectasias gástricas. Con base en este caso clínico y  la  pertinente  revisión  de  la  literatura,  se  propone  un  enfoque diagnóstico y terapéutico como parte del abordaje de esta enfermedad. Conclusión: la telangiectasia hemorrágica hereditaria al ser una enfermedad rara con una alta carga de morbilidad, la cual puede llegar a ser un reto diagnóstico llegando a representar una causa de anemia severa de origen gastrointestinal.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-07-15T00:00:00Z
dc.date.available.none.fl_str_mv 2024-07-15T00:00:00Z
dc.date.issued.none.fl_str_mv 2024-07-15
dc.type.spa.fl_str_mv Artículo de revista
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dc.type.local.eng.fl_str_mv Journal article
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dc.identifier.issn.none.fl_str_mv 2215-7840
dc.identifier.doi.none.fl_str_mv 10.32997/rcb-2024-3959
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dc.relation.ispartofjournal.spa.fl_str_mv Revista Ciencias Biomédicas
dc.relation.bitstream.none.fl_str_mv https://revistas.unicartagena.edu.co/index.php/cbiomedicas/article/download/3959/3898
dc.relation.citationendpage.none.fl_str_mv 155
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dc.relation.citationstartpage.none.fl_str_mv 147
dc.relation.citationvolume.spa.fl_str_mv 13
dc.relation.references.spa.fl_str_mv Dakeishi M, Shioya T, Wada Y, Shindo T, Otaka K, Manabe M, et al. Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Human Mutation. 2002 Jan 7;19 (2):140–8.
Pierucci P, Lenato GM, Suppressa P, Lastella P, Triggiani V, Valerio R, et al. A long diagnostic delay in patients with Hereditary Haemorrhagic Telangiectasia: a questionnaire-based retrospective study. Orphanet Journal of Rare Diseases. 2012 Jun 7;7 (1).
Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJJ, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). American Journal of Medical Genetics. 2000 Mar 6;91 (1):66–7.
McDonald J, Wooderchak-Donahue W, VanSant Webb C, Whitehead K, Stevenson DA, Bayrak-Toydemir P. Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Frontiers in Genetics. 2015 Jan 26;6.
Sánchez-Martínez R, Iriarte A, Mora-Luján JM, Patier JL, López-Wolf D, Ojeda A, et al. Current HHT genetic overview in Spain and its phenotypic correlation: data from RiHHTa registry. Orphanet Journal of Rare Diseases. 2020 Jun 5;15 (1).
Abdalla SA. Hereditary haemorrhagic telangiectasia: current views on genetics and mechanisms of disease. Journal of Medical Genetics. 2005 Jun 17;43 (2):97–110.
Govani FS, Giess A, Mollet IG, Begbie ME, Jones MD, Game L, et al. Directional Next-Generation RNA Sequencing and Examination of Premature Termination Codon Mutations in Endoglin/Hereditary Haemorrhagic Telangiectasia. Molecular Syndromology. 2013;4(4):184–96.
Giordano P, Lenato GM, Suppressa P, Lastella P, Dicuonzo F, Chiumarulo L, et al. Hereditary Hemorrhagic Telangiectasia: Arteriovenous Malformations in Children. The Journal of Pediatrics. 2013 Jul;163 (1):179-186.e3.
Shovlin CL. Hereditary haemorrhagic telangiectasia: Pathophysiology, diagnosis and treatment. Blood Reviews. 2010 Nov;24 (6):203–19.
Latino GA, Al-Saleh S, Alharbi N, Edwards C, Faughnan ME, Ratjen F. Prevalence of Pulmonary Arteriovenous Malformations in Children versus Adults with Hereditary Hemorrhagic Telangiectasia. The Journal of Pediatrics. 2013 Jul;163 (1):282–4.
Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJJ, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). American Journal of Medical Genetics. 2000 Mar 6;91 (1):66–7.
Faughnan ME, Mager JJ, Hetts SW, Palda VA, Ratjen F. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Annals of Internal Medicine. 2021 Jul;174(7):1035–6.
Faughnan ME, Mager JJ, Hetts SW, Palda VA, Ratjen F. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Annals of Internal Medicine. 2021 Jul;174 (7):1035–6.
Vascular Disease and the Growth, Repair, Regeneration and Degeneration of Vascular Elastic Membranes. Nutrition Reviews. 2009 Apr 27;18 (3):67–70.
Gaillard S, Dupuis-Girod S, Boutitie F, Rivière S, Morinière S, Hatron P-Y., et al. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. Journal of Thrombosis and Haemostasis. 2014 Jul 29;12(9):1494–502.
Geisthoff UW, Seyfert UT, Kübler M, Bieg B, Plinkert PK, König J. Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid - a double-blind placebo-controlled cross-over phase IIIB study. Thrombosis Research. 2014 Sep;134 (3):565–71.
Dupuis-Girod S, Ginon I, Saurin J-C, Marion D, Guillot E, Decullier E, et al. Bevacizumab in Patients With Hereditary Hemorrhagic Telangiectasia and Severe Hepatic Vascular Malformations and High Cardiac Output. JAMA. 2012 Mar 7;307(9).
Thompson AB, Ross DA, Berard P, Figueroa-Bodine J, Livada N, Richer SL. Very Low Dose Bevacizumab for the Treatment of Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia. Allergy & Rhinology. 2014 Jan;5 (2):ar.2014.5.0091.
Chavan A, Schumann-Binarsch S, Schmuck B, Oltmer F, Geisthoff U, Hoppe F, et al. Emerging role of bevacizumab in management of patients with symptomatic hepatic involvement in Hereditary Hemorrhagic Telangiectasia. American Journal of Hematology. 2017 Aug 24;92 (11):E641–4.
Iyer VN, Apala DR, Pannu BS, Kotecha A, Brinjikji W, Leise MD, et al. Intravenous Bevacizumab for Refractory Hereditary Hemorrhagic Telangiectasia–Related Epistaxis and Gastrointestinal Bleeding. Mayo Clinic Proceedings. 2018 Feb;93 (2):155–66.
Epperla N, Kapke JT, Karafin M, Friedman KD, Foy P. Effect of systemic bevacizumab in severe hereditary hemorrhagic telangiectasia associated with bleeding. American Journal of Hematology. 2016 Apr 28;91 (6):E313–4.
Al-Samkari H, Kritharis A, Rodriguez-Lopez JM, Kuter DJ. Systemic bevacizumab for the treatment of chronic bleeding in hereditary haemorrhagic telangiectasia. Journal of Internal Medicine. 2018 Oct 9;285(2):223–31.
Rosenberg T, Fialla AD, Kjeldsen J, Kjeldsen AD. Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series. Rhinology journal. 2019 Jan 1;0(0).
Guilhem A, Fargeton A-E, Simon A-C, Duffau P, Harle J-R, Lavigne C, et al. Intra-venous bevacizumab in hereditary hemorrhagic telangiectasia (HHT): A retrospective study of 46 patients. de Jesus Perez VA, editor. PLOS ONE. 2017 Nov 30;12 (11):e0188943.
van Tuyl SAC, Letteboer TGW, Rogge-Wolf C, Kuipers EJ, Snijder RJ, Westermann CJJ, et al. Assessment of intestinal vascular malformations in patients with hereditary hemorrhagic teleangiectasia and anemia. European Journal of Gastroenterology & Hepatology. 2007 Feb;19 (2):153–8.
Canzonieri C, Centenara L, Ornati F, Pagella F, Matti E, Alvisi C, et al. Endoscopic evaluation of gastrointestinal tract in patients with hereditary hemorrhagic telangiectasia and correlation with their genotypes. Genetics in Medicine. 2014 Jan;16 (1):3–10.
Ingrosso M, Sabbà C, Pisani A, Principi M, Gallitelli M, Cirulli A, et al. Evidence of Small-Bowel Involvement in Hereditary Hemorrhagic Telangiectasia: a Capsule-Endoscopic Study. Endoscopy. 2004 Dec;36 (12):1074–9.
Becq A, Rahmi G, Perrod G, Cellier C. Hemorrhagic angiodysplasia of the digestive tract: pathogenesis, diagnosis, and management. Gastrointestinal Endoscopy. 2017 Nov;86 (5):792–806.
Kwan V, Bourke MJ, Williams SJ, Gillespie PE, Murray MA, Kaffes AJ, et al. Argon Plasma Coagulation in the Management of Symptomatic Gastrointestinal Vascular Lesions: Experience in 100 Consecutive Patients with Long-Term Follow-Up. The American Journal of Gastroenterology. 2006 Jan;101 (1):58–63.
Zaffar N, Ravichakaravarthy T, Faughnan ME, Shehata N. The use of anti-fibrinolytic agents in patients with HHT: a retrospective survey. Annals of Hematology. 2014 Jul 27;94 (1):145–52.
Faughnan ME, Gossage JR, Chakinala MM, Oh SP, Kasthuri R, Hughes CCW, et al. Pazopanib may reduce bleeding in hereditary hemorrhagic telangiectasia. Angiogenesis. 2018 Sep 6;22 (1):145–55.
EASL Clinical Practice Guidelines: Vascular diseases of the liver. Journal of Hepatology. 2016 Jan;64 (1):179–202.
Buscarini E, Danesino C, Olivieri C, Lupinacci G, De Grazia F, Reduzzi L, et al. Doppler Ultrasonographic Grading of Hepatic Vascular Malformations in Hereditary Hemorrhagic Telangiectasia - Results of Extensive Screening. Ultraschall in der Medizin - European Journal of Ultrasound. 2004 Sep 14;25(05):348–55.
Caselitz M. Sonographic criteria for the diagnosis of hepatic involvement in hereditary hemorrhagic telangiectasia (HHT). Hepatology. 2003 May;37(5):1139–46.
Schelker RC, Barreiros AP, Hart C, Herr W, Jung E-M. Macro- and microcirculation patterns of intrahepatic blood flow changes in patients with hereditary hemorrhagic telangiectasia. World Journal of Gastroenterology. 2017;23 (3):486.
Buonamico P, Suppressa P, Lenato GM, Pasculli G, D’Ovidio F, Memeo M, et al. Liver involvement in a large cohort of patients with hereditary hemorrhagic telangiectasia: Echo-color-Doppler vs multislice computed tomography study. Journal of Hepatology. 2008 May;48 (5):811–20.
Buscarini E, Gebel M, Ocran K, Manfredi G, Del Vecchio Blanco G, Stefanov R, et al. Interobserver Agreement in Diagnosing Liver Involvement in Hereditary Hemorrhagic Telangiectasia by Doppler Ultrasound. Ultrasound in Medicine & Biology. 2008 May;34(5):718–25.
Wu JS, Saluja S, Garcia-Tsao G, Chong A, Henderson KJ, White RI. Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients. American Journal of Roentgenology. 2006 Oct;187 (4):W399–405.
Scardapane A, Stabile Ianora A, Sabbà C, Moschetta M, Suppressa P, Castorani L, et al. Dynamic 4D MR angiography versus multislice CT angiography in the evaluation of vascular hepatic involvement in hereditary haemorrhagic telangiectasia. 2011 Jun 4;117 (1):29–45.
Milot L, Kamaoui I, Gautier G, Pilleul F. Hereditary-hemorrhagic telangiectasia: One-step magnetic resonance examination in evaluation of liver involvement. Gastroentérologie Clinique et Biologique. 2008 Aug;32(8-9):677–85.
Al-Samkari H, Kasthuri RS, Parambil JG, Albitar HA, Almodallal YA, Vázquez C, et al. An international, multicenter study of intravenous bevacizumab for bleeding in hereditary hemorrhagic telangiectasia: the InHIBIT-Bleed study. Haematologica. 2021;106(8):2161-9.
Chen H, Zhang Z, Chen X, Wang C, Chen M, Liao H, et al. Meta-analysis of efficacy and safety of bevacizumab in the treatment of hereditary hemorrhagic telangiectasia epistaxis. Front Pharmacol. 2023;14:1089847.
Kwan V, Bourke MJ, Williams SJ, Gillespie PE, Murray MA, Kaffes AJ, Henriquez MS, Chan RO. Argon plasma coagulation in the management of symptomatic gastrointestinal Am J Gastroenterol. 2006;101(1):58.
Jackson SB, Villano NP, Benhammou JN, Lewis M, Pisegna JR, Padua D. Gastrointestinal Manifestations of Hereditary Hemorrhagic Telangiectasia (HHT): A Systematic Review of the Literature. Dig Dis Sci. 2017;62(10):2623-30.
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spelling Pinto Angarita, JeanGarcía del Risco, FernandoPuello Ramos, Walter2024-07-15T00:00:00Z2024-07-15T00:00:00Z2024-07-152215-784010.32997/rcb-2024-39592389-7252https://doi.org/10.32997/rcb-2024-3959Introducción: la telangiectasia hemorrágica hereditaria o enfermedad de Osler-Weber-Rendu es una entidad  autosómica  dominante rara, con una frecuencia que oscila entre 1 por cada 5000 habitantes a 1 por cada 1331 dependiendo de la población y localización geográfica. Se caracteriza clínicamente por telangiectasias, epistaxis a repetición, lesiones viscerales vasculares como angioectasias y MAVs (malformaciones arteriovenosas). El diagnóstico se sospecha con tres de los 4 criterios de Curazao y se confirma con estudios genéticos y complementarios. El tratamiento para las angioectasias es el Argón plasma  y para  la MAV tratamiento médico con bevacizumab, embolización o resección quirúrgica y en última instancia trasplante hepático. El pronóstico es favorable si las complicaciones son diagnosticadas y tratadas a tiempo. Caso clínico: se presenta el caso de una paciente de 51 años de edad que se presentó con astenia y adinamia en la que se documentó telangiectasias en lengua, labios y dedos y se llegó al diagnóstico de telangiectasia hemorrágica hereditaria luego de la confirmación de malformación arteriovenosa hepática y telangiectasias gástricas. Con base en este caso clínico y  la  pertinente  revisión  de  la  literatura,  se  propone  un  enfoque diagnóstico y terapéutico como parte del abordaje de esta enfermedad. Conclusión: la telangiectasia hemorrágica hereditaria al ser una enfermedad rara con una alta carga de morbilidad, la cual puede llegar a ser un reto diagnóstico llegando a representar una causa de anemia severa de origen gastrointestinal.Introduction: hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is a rare autosomal dominant entity, with a frequency ranging from 1 in 5000 inhabitants to 1 in 1331 depending on the population and geographic location. It is clinically characterized by telangiectasias, repeated epistaxis, visceral vascular lesions such as angioectasias and AVMs (arteriovenous malformations). The diagnosis is suspected with three of the 4 Curacao criteria and is confirmed with genetic and complementary studies. The treatment for angioectasias is Argon plasma and for AVM medical treatment with bevacizumab, embolization or surgical resection and ultimately liver transplant. The prognosis is favorable if complications are diagnosed and treated in time. Clinic case: en este reporte se presenta un caso de mononucleosis infecciosa por Virus de Epstein-Barr, en el que se destaca un curso de enfermedad en un grupo etario poco común, con compromiso de función hepática que resuelve con tratamiento sintomático. Conclusions: HHT is a rare disease with a high burden of disease, which can become a diagnostic challenge and can represent a cause of severe anemia of gastrointestinal origin.application/pdfspaUniversidad de CartagenaRevista Ciencias Biomédicashttps://revistas.unicartagena.edu.co/index.php/cbiomedicas/article/download/3959/3898155314713Dakeishi M, Shioya T, Wada Y, Shindo T, Otaka K, Manabe M, et al. Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Human Mutation. 2002 Jan 7;19 (2):140–8.Pierucci P, Lenato GM, Suppressa P, Lastella P, Triggiani V, Valerio R, et al. A long diagnostic delay in patients with Hereditary Haemorrhagic Telangiectasia: a questionnaire-based retrospective study. Orphanet Journal of Rare Diseases. 2012 Jun 7;7 (1).Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJJ, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). American Journal of Medical Genetics. 2000 Mar 6;91 (1):66–7.McDonald J, Wooderchak-Donahue W, VanSant Webb C, Whitehead K, Stevenson DA, Bayrak-Toydemir P. Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Frontiers in Genetics. 2015 Jan 26;6.Sánchez-Martínez R, Iriarte A, Mora-Luján JM, Patier JL, López-Wolf D, Ojeda A, et al. Current HHT genetic overview in Spain and its phenotypic correlation: data from RiHHTa registry. Orphanet Journal of Rare Diseases. 2020 Jun 5;15 (1).Abdalla SA. Hereditary haemorrhagic telangiectasia: current views on genetics and mechanisms of disease. Journal of Medical Genetics. 2005 Jun 17;43 (2):97–110.Govani FS, Giess A, Mollet IG, Begbie ME, Jones MD, Game L, et al. Directional Next-Generation RNA Sequencing and Examination of Premature Termination Codon Mutations in Endoglin/Hereditary Haemorrhagic Telangiectasia. Molecular Syndromology. 2013;4(4):184–96.Giordano P, Lenato GM, Suppressa P, Lastella P, Dicuonzo F, Chiumarulo L, et al. Hereditary Hemorrhagic Telangiectasia: Arteriovenous Malformations in Children. The Journal of Pediatrics. 2013 Jul;163 (1):179-186.e3.Shovlin CL. Hereditary haemorrhagic telangiectasia: Pathophysiology, diagnosis and treatment. Blood Reviews. 2010 Nov;24 (6):203–19.Latino GA, Al-Saleh S, Alharbi N, Edwards C, Faughnan ME, Ratjen F. Prevalence of Pulmonary Arteriovenous Malformations in Children versus Adults with Hereditary Hemorrhagic Telangiectasia. The Journal of Pediatrics. 2013 Jul;163 (1):282–4.Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJJ, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). American Journal of Medical Genetics. 2000 Mar 6;91 (1):66–7.Faughnan ME, Mager JJ, Hetts SW, Palda VA, Ratjen F. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Annals of Internal Medicine. 2021 Jul;174(7):1035–6.Faughnan ME, Mager JJ, Hetts SW, Palda VA, Ratjen F. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Annals of Internal Medicine. 2021 Jul;174 (7):1035–6.Vascular Disease and the Growth, Repair, Regeneration and Degeneration of Vascular Elastic Membranes. Nutrition Reviews. 2009 Apr 27;18 (3):67–70.Gaillard S, Dupuis-Girod S, Boutitie F, Rivière S, Morinière S, Hatron P-Y., et al. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. 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Dig Dis Sci. 2017;62(10):2623-30.JEAN PINTO - 2024https://creativecommons.org/licenses/by-nc-nd/4.0http://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessEsta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.https://revistas.unicartagena.edu.co/index.php/cbiomedicas/article/view/3959sangrado oscuroanemia ferropénicacapsula endoscópicatelangiectasia hemorrágica hereditariaRendu Osler Weberangioectasiaobscure bleedingiron deficiency anemiacapsule endoscopyangiodysplasiahereditary hemorrhagic telangiectasiaRendu Osler WeberTelangiectasia hemorrágica hereditaria como causa de anemia ferropénica grave de origen oscuroHereditary hemorrhagic telangiectasia as a cause of severe iron deficiency anemia of obscure originArtículo de revistainfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articleJournal articlehttp://purl.org/redcol/resource_type/ARTREFPublicationOREORE.xmltext/xml2680https://repositorio.unicartagena.edu.co/bitstreams/d587bf1e-a539-4631-be0f-0d407c6a4b70/downloada20f3cc63813ae1e5f777161e2a00322MD5111227/18745oai:repositorio.unicartagena.edu.co:11227/187452025-02-12 05:00:18.244https://creativecommons.org/licenses/by-nc-nd/4.0JEAN PINTO - 2024metadata.onlyhttps://repositorio.unicartagena.edu.coBiblioteca Digital Universidad de Cartagenabdigital@metabiblioteca.com

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