**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Prof G Avery    |  ARSAC Licence Holder  |    |  2024-12-24      |

====== REF024 - Gastro-Intestinal Bleeding Scintigraphy ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer.


=====  Description =====
The localisation of gastrointestinal bleeding is usually with endoscopy or radiographic procedures  - CT or catheter angiography.  In problematic cases, however, the use of technetium-99m labelled red blood cells may contribute to the management of a patient who is actively bleeding.

A site of active bleeding is localised by an accumulation of labelled red blood cells in the abdomen and the general configuration of radiopharmaceutical in the gut lumen can give some localisation.  This can also assist in the choice of mesenteric vessel to catheterise first if angiography is to be performed afterwards.

A red blood cell study can be positive at bleeding rates of 0.5 ml per minute.  In some cases, bleeding rates as low as 0.1 ml per minute may be detected. The study should be performed rapidly after bleeding is detected.  

There is often a problem with the timing of this investigation, either because the bleeding is intermittent or because a patient admitted to hospital with a gastrointestinal haemorrhage is stabilised before examination by which time the bleeding has stopped. 



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SELECT nuclide AS Nuclide, pharmaceutical_form AS "Pharmaceutical Form",  
local_drl AS "Local DRL (MBq)" FROM drls INNER JOIN nuclides ON drls.nuclide_id=nuclides.id 
WHERE drls.id=8|0]]

^  ^  Radiopharmaceutical   ^  CT  ^
^Typical Radiation Dose (mSv)  |  2.8  |  3.2  | 

===== Staff Permitted to Refer =====
The referrer may be any clinician holding a current valid medical qualification and currently employed in Secondary Care.

Referring clinicians are reminded of the requirement to avoid unnecessary exposure to ionising radiation.  The investigation may already have been requested at this hospital or elsewhere and clinicians are asked to be particularly vigilant to ensure that their request is not a double request.

===== Supplementary Drugs =====
Sodium chloride for parenteral use (0.9% w/v) \\
Stannous Agent/Sodium pyrophosphate

===== Contraindications =====
^Patient Demographics  | Pregnancy    |

===== Referral Criteria =====
Sufficient clinical information must be provided to justify the investigation proceeding.

The clinical indications are detailed below.

^Investigation  |
|Localisation of a site of active gastrointestinal bleeding  |


===== Patient Preparation =====

  * If the patient is haemodynamically unstable they will need to be monitored by a doctor or nurse when in the department[([[https://snmmi.org/Web/Clinical-Practice/Procedure-Standards/Standards/Gastrointestinal%20Bleeding%20Scintigraphy%203_0|The SNMMI/ACNM Procedure Standard for Gastrointestinal Bleeding Scintigraphy 3.0. [Online - Accessed on 28/11/2024]]])]. Please note that the nuclear medicine department do not have staff who can monitor such patients.

===== References =====