Osler-Weber-Rendu syndrome is a disorder of the blood vessels that can cause excessive bleeding. The abnormal blood vessels can cause bleeding both into the skin and inside your body. The treatment may include blood transfusions for severe bleeding as well as treatment of abnormal blood vessels. There is usually no effect on life expectancy. However, heart failure and severe liver disease (liver cirrhosis) may develop as complications of Osler-Weber-Rendu syndrome.
What is Osler-Weber-Rendu syndrome?
Osler-Weber-Rendu syndrome is a disorder of the blood vessels that can cause excessive bleeding. Osler-Weber-Rendu syndrome is also called hereditary haemorrhagic telangiectasia. People with Osler-Weber-Rendu syndrome can develop abnormal blood vessels in several areas of the body. These vessels are called arteriovenous malformations. The abnormal blood vessels in the skin are called telangiectasias. There are also abnormal connections between arteries and capillaries (called arteriovenous malformations, or AVMs). These AVMs particularly occur in the lungs, liver and brain.
What causes Osler-Weber-Rendu syndrome?
Osler-Weber-Rendu syndrome is inherited, which means it is passed down through families. Scientists have identified four genes involved in this condition. All these genes appear to be important for blood vessels to develop properly.
How common is Osler-Weber-Rendu syndrome?
Osler-Weber-Rendu syndrome is uncommon and occurs in about 1 in 6,000 people.
What symptoms does Osler-Weber-Rendu syndrome cause?
The symptoms will depend on the location of the abnormal blood vessels. The first symptom is often recurrent nosebleeds as a teenager. Abnormal blood vessels (telangiectasias) in the skin are often not seen until 20-30 years of age. Abnormal blood vessels also often occur on the lips, tongue and the lining of the nose. They may also occur on the white surface of the eye (conjunctiva), lining of the gut (gastrointestinal tract), lungs, brain and liver.
Therefore, the symptoms may include:
- Abnormal blood vessels on the skin, lips and white surface of your eyes.
- Bringing up (vomiting) blood or passing very dark stools (faeces) - bleeding from your gut.
- Headaches, fits (seizures) and bleeding into the brain (stroke).
- Coughing up blood - bleeding into the lungs (which is called haemoptysis).
- Tiredness, weakness and feeling faint (symptoms of anaemia caused by bleeding inside your body).
Abnormal blood vessels in the liver may cause increased blood flow in the liver. This may cause heart failure with shortness of breath.
How is Osler-Weber-Rendu syndrome diagnosed?
Tests to diagnose Osler-Weber-Rendu syndrome include blood tests, scans of your heart (called an echocardiogram), using an endoscope to look at both ends of your gut (bowel), CT scans and MRI scans. Genetic testing is used to look for changes in the genes associated with Osler-Weber-Rendu syndrome. Genetic testing can also be used to see if anyone else in your family also has an abnormal gene (mutation).
What is the treatment for Osler-Weber-Rendu syndrome?
Severe bleeding may need a blood transfusion. Surgery, local intense heat treatment (electrocautery) or laser treatment may also be needed for areas of bleeding.
Arteriovenous malformations (AVMs) can be treated by injecting a substance into the blood vessel (embolisation) to block the abnormal blood vessel.
Female hormones (oestrogens) have been shown to be effective. The combined oral contraceptive pill (containing oestrogen and progestogen) is often used for women who have Osler-Weber-Rendu syndrome.
What are the possible complications of Osler-Weber-Rendu syndrome?
The complications of Osler-Weber-Rendu Syndrome may include severe bleeding (haemorrhage), heart failure and high blood pressure in the lungs (pulmonary hypertension). Severe liver disease (liver cirrhosis) may occur in a small number of those with this condition.
What is the outlook (prognosis)?
There is usually no effect on lifespan. However, severe internal bleeding or severe liver disease (liver cirrhosis) may cause early death.
Further reading and references
Shovlin CL, Guttmacher AE, Buscarini E, et al; Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet. 2000 Mar 691(1):66-7.
Garg N, Khunger M, Gupta A, et al; Optimal management of hereditary hemorrhagic telangiectasia. J Blood Med. 2014 Oct 155:191-206. doi: 10.2147/JBM.S45295. eCollection 2014.
Begbie ME, Wallace GM, Shovlin CL; Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): a view from the 21st century. Postgrad Med J. 2003 Jan79(927):18-24.
McDonald J, Wooderchak-Donahue W, VanSant Webb C, et al; Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Front Genet. 2015 Jan 266:1. doi: 10.3389/fgene.2015.00001. eCollection 2015.
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