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Artefactual “in-vitro coagulopathy” in a patient with non-Hodgkin lymphoma and lower gastrointestinal bleeding

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Clinical record

An 80-year-old man presented in August 2012 with lower gastrointestinal bleeding 3 days after a routine colonoscopy and polypectomy as a day procedure. Five sessile polyps had been excised from the right colon (one from the caecum, one from the hepatic flexure and three from the transverse colon); the largest polyp measured 8 mm. Additionally, a 20 mm sessile polyp was excised from the rectum by means of chromogel elevation and endoscopic mucosal resection.1 A resultant defect in the muscularis propria was closed with five endoclips. The patient was discharged in the evening, well after the procedure. Subsequent histopathological examination showed that the polyps were tubular or tubulovillous adenomas without dysplasia.

Three days after initial polypectomy the patient was woken from sleep by abdominal discomfort and an episode of passing about 500 mL of fresh blood from the rectum. On presenting to the emergency department, he continued to bleed, although at a slower rate. He was asymptomatic and haemodynamically stable. His haemoglobin level was 115 g/L (reference interval [RI], 130–180 g/L) on presentation, and dropped to 98 g/L after a second large bleed 8 hours later. His blood urea nitrogen level on admission was elevated (12.6 mmol/L; RI, 3.0–8.0 mmol/L), consistent with a gastrointestinal…