A Case of Amyloidosis with Gastrointestinal Hemorrhage Successfully Treated with Tranexamic Acid
Bibliographic record
Abstract
Purpose: A 52-year old woman presented with melena. There was a past history of cholecystectomy, choledocholithiasis, and hysterectomy for menorrhagia, complicated by severe intra-operative bleeding. EGD demonstrated serpiginous, oozing lesions in the duodenal bulb and the gastric body and fundus. Radiologic imaging suggested the presence of intra-abdominal varices. Hepatic venous pressure gradient was elevated at 15 mmHg, in keeping with portal hypertension. Transjugular liver biopsy demonstrated amyloidosis. Subsequently, the patient's hysterectomy specimen was reviewed and amyloidosis was noted in the vasculature. The patient had ongoing bleeding and consideration was given to endoscopic therapy or transjugular intra-hepatic port-systemic shunting, but decided against because of the risk of hemorrhage. Instead, she was treated with tranexamic acid 800 mg IV every 6 hours for 10 days followed by 500 mg orally every 6 hours for three weeks. There were no further episodes of bleeding. The patient was treated with a combination of melphalan and prednisone for the amyloidosis, but deteriorated with respect to cardiac function. She ultimately succumbed to severe congestive heart failure 9 months later. GI bleeding is known to occur in amyloidosis and is generally due to mucosal infiltration with amyloid. Portal hypertension of the pre-sinusoidal type has been described in some amyloidosis patients. The GI bleeding in this case may have been due to both factors. There is some evidence that amyloidosis can be associated with deranged fibrinolysis. In this case, use of the anti-fibrinolytic agent tranexamic acid was associated with resolution of GI bleeding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".