showed: RBC 2.0110 12 /L, PLT 9810 9 /L, 3+ fecal occult blood, CRP 5.7 mg/L, and characteristic renal metabolic derangements (pre-dialysis Cr 804 mol/L, K+ 6.3 mmol/L),autoantibodies and tumor markers were negative, and abdominal CT revealed no specific abnormalities.Colonoscopy demonstrates multiple spider-like vascular dilatations in the ileocecal region (Figure),comprehensive imaging and endoscopic evaluation ultimately identified colonic telangiectasias via colonoscopy, while excluding other bleeding sources.Following ethical approval andpatient consented, thalidomide therapy was initiated(50mg qd po).Results: Fecal occult blood turned negative within 5 days of treatment initiation.Post-discharge therapy continuation included ongoing EPO administration and oral iron supplementation.Hemoglobin levels demonstrated progressive improvement: 68 g/L at 1-month follow-up, 80 g/L at 2-month follow-up.Thalidomide was discontinued per protocol at the 2-month mark.At the 3-month post-discontinuation assessment: Hemoglobin remained stable at 85 g/L,no recurrent gastrointestinal bleeding,persistent absence of fecal occult blood.Conclusion: Colonoscopy proves instrumental in diagnosing refractory gastrointestinal bleeding during maintenance hemodialysis.Thalidomide demonstrates clinical efficacy for hemodialysis-associated intestinal vascular dysplasia-related hemorrhage, likely mediated through inhibition of vascular endothelial growth factor production.Declaration of Generative AI and AI-assisted technologies in the writing process.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Diallo et al. (Wed,) studied this question.