Severe Bladder Bleeding in Glanzmann Thrombasthenia Successfully Treated With Artery Embolization

Severe bleeding can be especially difficult to manage in people with Glanzmann Thrombasthenia (GT) when the source of the bleeding cannot be controlled through conventional treatment.

A 2026 case report describes a 66-year-old man with Glanzmann Thrombasthenia who developed life-threatening blood in his urine caused by multiple rare vascular tumors in his bladder. After the bleeding returned despite transfusions, recombinant activated factor VII (rFVIIa), and an endoscopic procedure, physicians successfully stopped it using a minimally invasive procedure called super-selective vesical artery embolization.

The case highlights how directly treating the source of bleeding may be an option in certain complex situations when conventional approaches fail, or surgery carries substantial bleeding risk.

Easy-to-Understand Summary

A 66-year-old man with Glanzmann Thrombasthenia developed severe bleeding from his bladder. Doctors found several bladder hemangiomas, rare, noncancerous growths made of blood vessels.

His bleeding became severe enough to cause significant blood loss and large blood clots that obstructed his bladder.

Doctors initially treated him with:

• Red blood cell transfusions
• Platelet transfusions
• Recombinant activated factor VII (rFVIIa)
• An endoscopic procedure to cauterize the bleeding areas

The treatment initially worked, and the patient was discharged with his hemoglobin stabilized at 10.4 g/dL.

However, 12 days later, severe bleeding returned. His hemoglobin dropped to 6.8 g/dL, and additional platelet transfusions and rFVIIa did not stop the bleeding.

Another bladder procedure or more extensive surgery was considered particularly risky because of his Glanzmann Thrombasthenia.

Instead, doctors used a catheter to reach and block the small arteries supplying blood to the abnormal areas of his bladder. This procedure is called super-selective vesical artery embolization.

The results were significant. His bleeding completely stopped within 72 hours, and at his six-month follow-up, he had experienced no additional blood in his urine and no reported complications from the procedure.

What Are Bladder Hemangiomas?

A bladder hemangioma is a rare, benign growth composed of blood vessels in the bladder.

According to the case report, bladder hemangiomas account for approximately 0.6% of bladder tumors. Although they are not cancerous, their vascular nature means they can cause bleeding.

Blood in the urine, medically known as hematuria, is a primary symptom.

In this case, the patient had multiple hemangiomas involving the posterior and right lateral walls of his bladder. The lesions were so small that a contrast-enhanced CT scan did not clearly identify them. Cystoscopy identified them, and biopsy confirmed them.

The combination of these vascular lesions and Glanzmann Thrombasthenia created an especially difficult bleeding situation.

How Was the Bleeding Initially Treated?

The patient’s first episode of hematuria worsened considerably following cystoscopy and bladder biopsy.

He eventually required multiple red blood cell and platelet transfusions along with intravenous rFVIIa.

Doctors also performed transurethral electrocoagulation, an endoscopic procedure used to cauterize the bleeding lesions.

Initially, the treatment appeared successful. His urine cleared, his hemoglobin stabilized at 10.4 g/dL, and he was discharged.

Twelve days later, however, he returned with severe bleeding and acute urinary retention caused by large blood clots. His hemoglobin had fallen to 6.8 g/dL.

Despite additional platelet transfusions and repeated administration of rFVIIa, the bleeding persisted.

What Is Super-Selective Vesical Artery Embolization?

Super-selective vesical artery embolization is a minimally invasive procedure that blocks specific blood vessels supplying a bleeding area of the bladder.

Rather than performing another procedure directly on the bladder lesions, physicians use angiography to locate the arteries supplying them.

Physicians guided a small catheter into the specific blood vessels feeding the abnormal areas. They then embolized those vessels, blocking their blood supply while limiting the effect on surrounding areas of the bladder.

This approach allowed doctors to target the physical source of the bleeding without performing major bladder surgery.

Did the Embolization Work?

Yes, in this patient.

The improvement occurred quickly:

• Within 24 hours: His urine went from heavily bloody to light pink.
• Within 72 hours: The visible bleeding completely stopped.
• Four days after the procedure: He was discharged.
• Six months later: He remained free of recurrent hematuria, with no reported complications related to the embolization.

The procedure provided lasting bleeding control during the six-month follow-up period reported by the authors.

Why Is This Case Important for the Glanzmann Thrombasthenia Community?

This case is particularly interesting because several attempts to support clotting or directly cauterize the lesions did not provide lasting control.

The patient’s GT was managed with platelet transfusions and rFVIIa, but the abnormal blood vessels in his bladder continued to provide a physical source of bleeding.

Ultimately, a multidisciplinary team of hematologists, urologists, and interventional radiologists addressed both problems: the patient’s underlying bleeding disorder and the specific blood vessels responsible for the hemorrhage.

The case demonstrates the potential importance of identifying and directly treating the source of severe bleeding when possible.

Does This Mean Embolization Is a Treatment for GT Bleeding?

No. This is an important limitation of the report.

This publication describes one patient with an unusual combination of Glanzmann Thrombasthenia and multiple bladder hemangiomas. It is not a clinical trial or treatment guideline.

Embolization was considered because the patient had an identifiable vascular source of bleeding, previous endoscopic treatment had failed, severe bleeding had returned, and additional surgery was considered particularly dangerous.

The successful outcome should therefore not be interpreted as meaning embolization is appropriate for routine GT bleeding.

Instead, this case shows how an individualized approach may help manage a rare and complicated bleeding situation.

What Can We Learn From This Case?

For this patient, hematological treatments were important but did not permanently eliminate the underlying source of his bleeding. Directly targeting the blood vessels supplying the bladder lesions ultimately stopped the hemorrhage without requiring major surgery.

The case reinforces an important point for the GT community: bleeding management is not always one-size-fits-all.

The cause, location, severity, previous treatments, and individual patient’s bleeding history all matter. Complex cases may also benefit from collaboration between hematologists and specialists who can address the specific source of bleeding.

People with Glanzmann Thrombasthenia experiencing significant or unusual bleeding should work with their hematology team and appropriate specialists to determine the best approach for their individual situation.

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