A man in his 20s presented with progressive fatigue and melena, with a history of recurrent epistaxis since adolescence and a positive family history. Evaluation revealed severe iron-deficiency anaemia (haemoglobin 27 g/L) with persistently positive faecal occult blood. Upper gastrointestinal endoscopy demonstrated multiple bleeding telangiectasias in the stomach and duodenum. Cross-sectional imaging of abdomen, thorax and brain identified multisystem arteriovenous malformations involving the liver, lung and brain. Despite repeated argon plasma coagulation and thalidomide therapy, bleeding persisted with ongoing transfusion dependence. Treatment with intravenous bevacizumab and subcutaneous octreotide stabilised haemoglobin and resolved occult gastrointestinal bleeding. A clinical diagnosis of hereditary haemorrhagic telangiectasia was established using Curaçao criteria despite negative genetic testing. This case highlights the importance of recognising hereditary haemorrhagic telangiectasia in unexplained severe anaemia and supports the role of anti-angiogenic therapy in refractory gastrointestinal bleeding.

Anemia is one of the most common complications affecting individuals with chronic kidney disease (CKD). It is driven primarily by relative erythropoietin (EPO) deficiency, chronic inflammation, and altered iron metabolism. Emerging therapies, known as hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), offer a novel oral treatment approach by stabilizing intracellular HIF levels to mimic tissue hypoxia and stimulate endogenous EPO production. This comprehensive narrative review synthesizes literature indexed in PubMed, MEDLINE, Scopus, and Web of Science to evaluate the efficacy of HIF stabilizers in the anemia of CKD compared to current guideline-directed therapies worldwide. Phase 3 clinical trials consistently demonstrate that HIF-PHIs are non-inferior to conventional erythropoiesis-stimulating agents (ESAs) and superior to placebo in increasing and maintaining hemoglobin levels in both dialysis-dependent and non-dialysis-dependent CKD patients. Additionally, HIF-PHIs improve iron mobilization and utilization by decreasing hepcidin levels. However, trials have raised safety concerns regarding cardiovascular outcomes, including major adverse cardiovascular events, and an increased incidence of thromboembolic events, particularly in non-dialysis-dependent populations. These safety signals have led to divergent global regulatory pathways, with the United States Food and Drug Administration largely restricting approvals to dialysis-dependent patients, while agencies in Europe and Japan have granted broader authorizations. As a growing body of literature accumulates, HIF-PHIs offer a promising oral alternative to ESAs that addresses both relative EPO deficiency and iron sequestration. While they have the potential to become a new standard of care, therapy initiation requires individualized risk-benefit assessments, and continued post-marketing surveillance is necessary to fully elucidate long-term cardiovascular and thromboembolic risks.

Dystrophic epidermolysis bullosa (DEB) is characterized by skin fragility manifested by blistering and erosions with minimal trauma. Many individuals also have dystrophic or absent nails. DEB is divided into two major types depending on inheritance pattern: recessive dystrophic epidermolysis bullosa (RDEB) and dominant dystrophic epidermolysis bullosa (DDEB). Clinical findings in severe RDEB include skin fragility manifested by blistering and erosions with minimal trauma that heals with milia and scarring. Blistering and erosions affecting the whole body may be present in the neonatal period. Oral involvement may lead to mouth blistering, fusion of the tongue to the floor of the mouth, and progressive diminution of the size of the oral cavity and mouth opening. Esophageal erosions can lead to webs and strictures that can cause severe dysphagia. Malnutrition with vitamin and mineral deficiency may lead to growth deficiency in young children. Corneal erosions can lead to scarring and loss of vision. Blistering of the hands and feet followed by scarring results in contractures and pseudosyndactyly. The lifetime risk of aggressive squamous cell carcinoma (SCC) is greater than 90%. In contrast, the blistering in intermediate RDEB may be localized to hands, feet, knees, and elbows with or without involvement of flexural areas and the trunk, and without severe scarring. In DDEB, blistering is often mild and limited to hands, feet, knees, and elbows, but nonetheless heals with scarring. Dystrophic nails, especially toenails, are common and may be the only manifestation of DDEB.

The clinical data of 4 pediatric patients with collagenous gastritis (CG) diagnosed at the Department of Pediatrics of Peking University Third Hospital between January 2021 and October 2025 were retrospectively analyzed. The median age at onset was 10.8 years. All patients presented with iron-deficiency anemia, and two also experienced abdominal pain. Gastroscopy in all cases revealed a nodular gastric mucosal appearance. Histopathological examination confirmed subepithelial collagen band thickness greater than 10 μm in all patients, with varied patterns of inflammatory infiltrate, including two cases with eosinophil-predominant inflammation and one with lymphocytic gastritis. Two patients were found to have collagenous duodenitis, while none showed collagenous colitis. Serological testing identified one patient with low-titer positive antinuclear antibodies and another with elevated gastrin-17 levels. Treatment consisted of iron supplementation in all cases, combined with gastric mucosal protectants in three patients and glucocorticoid therapy in one patient. Follow-up of three patients showed clinical improvement with resolution of anemia, and two also demonstrated histological improvement with reduced gastric inflammation and collagen deposition. Pediatric CG is characterized primarily by iron-deficiency anemia and nodular gastric mucosal changes, accompanied by duodenal involvement in some patients. These findings underline the importance of a comprehensive evaluation of the entire gastrointestinal tract. Diagnosis relies on distinct endoscopic and pathological features, while attention should also be paid to potential biomarkers. A combined treatment approach, including iron supplementation, mucosal protection, and glucocorticoids when necessary, may lead to clinical and histological remission.

Iron deficiency anemia (IDA) is common in older adults, and gastrointestinal bleeding is an important cause that should be investigated. However, identifying the bleeding source can be challenging when upper and lower gastrointestinal endoscopy findings are negative. We report the case of a 90-year-old woman who presented with anorexia, general fatigue, and dizziness and was found to have severe IDA with a hemoglobin level of 3.9 g/dL. Upper and lower gastrointestinal endoscopy failed to identify the bleeding source. Although her anemia initially improved after blood transfusion and iron supplementation, it recurred, requiring readmission. Double-balloon enteroscopy (DBE) revealed a submucosal tumor with ulceration in the ileum, and surgical resection confirmed an ileal gastrointestinal stromal tumor (GIST). Retrospective review of contrast-enhanced computed tomography (CT) images also identified the corresponding small bowel lesion. This case highlights the importance of considering small bowel lesions in patients with recurrent IDA despite negative findings on upper and lower gastrointestinal endoscopy. It also highlights the value of retrospectively reviewing existing CT images, which may reveal overlooked lesions. Our findings suggest that additional evaluation of the small bowel should be considered in patients with recurrent IDA regardless of advanced age.

This case describes a 40-year-old woman with gestational trophoblastic disease (GTD) who presented with vaginal bleeding, iron deficiency anemia, and a markedly elevated beta-human chorionic gonadotropin (β-hCG) of 1,889,800 mIU/mL. Transabdominal ultrasound revealed retained products of conception and GTD. The patient had experienced a failed pregnancy two months prior to presentation. She required a massive transfusion (five units of packed red blood cells) and underwent dilation and curettage under general anesthesia with rapid sequence intubation. This case examines the anesthetic considerations and perioperative complications associated with this high-risk case.

Heavy menstrual bleeding (HMB) is prevalent, with consequences impacting quality of life from adolescence through adulthood. Several clinical tools have been developed to aid in HMB diagnosis, which must be coupled with a detailed menstrual history. The diagnosis of HMB should be accompanied by evaluation of coexisting iron deficiency or iron deficiency anemia with appropriate treatment, and importantly, an in-depth evaluation for an underlying etiology. HMB is a significant hallmark of a bleeding disorder (BD) in adolescents; BDs are not often investigated and are underdiagnosed due to knowledge gaps, inconsistent referral practices, and lack of coordinated management by primary care providers, hematologists, and gynecology providers. Due to several missed opportunities, there is a substantial diagnostic delay of an underlying BD resulting in significant morbidity, risk of bleeding with future hemostatic challenges, and subsequent impact on undiagnosed family members. This review highlights issues related to HMB, associated iron deficiency/iron deficiency anemia, and the diagnostic journey for adolescents with BDs, emphasizing the roles of providers, community members, and other stakeholders to mitigate obstacles and create solutions to develop improved pathways to access best care for this population.