Scientific paper
Implications of negative technetium 99m–labeled red blood cell scintigraphy in patients presenting with lower gastrointestinal bleeding

Presented at the 49th Annual Meeting of the Midwest Surgical Association, Mackinac Island, MI, August 6–9, 2006
https://doi.org/10.1016/j.amjsurg.2006.12.006Get rights and content

Abstract

Background

Lower gastrointestinal (GI) bleeding frequently recurs after negative technetium 99m–labeled red blood cell (RBC) scintigraphy.

Methods

Between July 1, 1999 and July 31, 2005, 84 negative 99mTc-labeled RBC scintigrams were obtained for acute lower GI bleeding. Medical records were abstracted for age, gender, prior history of lower GI hemorrhage, length of hospitalization, initial hematocrit (Hct) and Hct nadir, transfusion requirements, cause of bleeding, use of anticoagulants and/or antiplatelet medications, and rebleeding episodes.

Results

The overall rate of rebleeding was 27% (n = 23). There were no significant associations between any of the patient variables investigated and rebleeding.

Conclusions

Despite negative 99mTc-labeled RBC scintigraphy, more than 25% of patients experience recurrent lower GI bleeding. Patient age, bleeding source, use of anticoagulant/antiplatelet medications, length of stay, admission Hct, Hct nadir, transfusion requirements, and gender are not predictive of the patients who will rebleed.

Section snippets

Patients and Methods

After institutional review board approval, a retrospective analysis of all 99mTc-labeled RBC scintigraphy studies at a single tertiary care level institution (Ochsner Clinic Foundation, New Orleans, LA) between July 1, 1999 and July 31, 2005 was performed. During this 6-year period, 170 patients underwent 227 99mTc scans for the evaluation of GI hemorrhage. One hundred thirteen of these scans were negative for active bleeding. Scans performed for the evaluation of upper or lower GI hemorrhage

Results

Over a 6-year period, 84 negative 99mTc scans were obtained on admission assessments of patients with clinical evidence of lower GI hemorrhage. This group consisted of 43 male (51%) and 41 female (49%) patients, with an average age of 75.2 (±11.01) years. Forty-nine patients (58%) had a prior history of lower GI bleeding. The mean admission Hct was 33.3 (±6.92), and the mean Hct nadir was 26.74 (±4.62). A mean of 2.87 (±2.6) units of PRBCs per patient were transfused during hospitalization. The

Comments

The evaluation and treatment of massive lower GI hemorrhage can be perplexing to even the most experienced clinician. Once patient resuscitation has been initiated and a thorough history and physical examination have been performed, multiple diagnostic modalities are available to characterize the site and cause of bleeding. In addition to their diagnostic capacities, colonoscopy and angiography can be used for therapeutic purposes in many instances. Radionuclide bleeding scintigraphy, using 99m

References (14)

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