This protocol addresses the management of patients with Hereditary hemorrhagic telangiectasia (HHT) who present with mild gastrointestinal bleeding and are currently meeting their hemoglobin goals on oral iron replacement.
The patient has mild HHT-related gastrointestinal bleeding and is able to maintain adequate hemoglobin levels through oral iron supplementation alone. This presentation defines a specific sub-population in which the threshold for escalating therapy is informed by whether iron replacement is sufficient to sustain hemoglobin targets.
Current evidence supports the use of an oral antifibrinolytic agent in this setting, on the basis of low potential for harm. The full structured regimen — including dosing guidance, sequencing, and clinical decision points — is in the complete protocol.
Full regimen details available in the structured protocol →DOI: 10.1182/blood.2020008739
Mild HHT-related GI bleeding: patient who meets their hemoglobin goals with oral iron replacement.
Tranexamic acid is recommended for patients with mild GI bleeding on the basis of low potential for harm, but there is limited evidence of effectiveness.
The expert panel recommends that clinicians consider treatment of mild HHT-related GI bleeding with oral antifibrinolytics.
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