Residents' Duty Hours and Professionalism

Abstract

To the Editor: We administered bevacizumab to a 65-year-old woman with HHT and life-threatening, recurrent hemorrhage. She had undergone liver transplantation 10 years earlier for arteriovenous shunting. Over a 1-year period, worsening anemia developed because of recurrent epistaxis and gastrointestinal bleeding, despite maximal standard therapy of iron infusions, estrogens, and tranexamic acid. From February through July 2008, she received 27 transfusions containing a total of 52 packed cells. Six courses of bevacizumab (5 mg per kilogram) were administered without any adverse events. Blood transfusions were not required for 2 months. Only medical therapy was continued. In December 2008, hemorrhage resumed, but with a reduced need for blood transfusion, as compared with her earlier course.Frederique Retornaz, M.D., Ph.D.Yves Rinaldi, M.D.Hôpital Ambroise ParéMarseille, Francefretornaz@cgd13.frChristophe Duvoux, M.D.Hôpital Henri-MondorCréteil, France