Severe gastrointestinal bleeding in a uremic patient treated with estrogen-progesterone therapy

Gastrointestinal bleeding is a frequent complication in hemodialysis patien ts; angiodysplasia is a potential cause, with a higher incidence in uremic patients. We describe a case of severe anemia (Hemoglobin up to 3.5 g/dl) s econdary to diffuse angiodysplastic lesions in a hemodialysis patient with mixed connective tissue disease. The case is characterised both by the seve rity of the clinical picture (extension and entity of angiodysplastic lesio ns, frequency of bleeding episodes) and by the patient's religious faith wh ich made her reject blood transfusions. We underline the efficacy of estrog en-progesterone therapy in view of the modest results obtained with other t herapeutic strategies on bleeding.