Recurrent spontaneous renal bleeding in a patient with a CYCS-gene related inherited thrombocytopaenia and ischaemic heart disease.

This is a case of an elderly male in his 80s, with a known CYCS-gene related inherited thrombocytopaenia and ischaemic heart disease who presents with three episodes of spontaneous renal bleeding. During the first two episodes of bleeding, he presents in haemorrhagic shock requiring resuscitation and blood transfusions, and renal artery embolisation as the definitive treatment. In view of his significant risk of bleeding, a decision was taken to stop aspirin only to present later with a third episode of renal bleeding. Despite a significant haemoglobin drop he remained stable and management was thus conservative. He presents later with further superficial bleeding and an acute coronary event. Due to his high bleeding risk, he had to be turned down for coronary intervention and was managed conservatively. To date, despite his multiple life-threatening conditions, the patient remains well, independent and with no further bleeding events.