Management of Bleeding Complications of Hematologic Malignancies

Abstract

Persons with hematologic malignancies bleed for a variety of reasons, including alterations in platelet function and numbers, clotting factor deficiencies, circulating anticoagulants, and defects in vascular integrity. The management of bleeding begins with a full characterization of the hemostatic defect. Vitamin K deficiency always should be considered and excluded by clinical history and laboratory tests. Localized bleeding is treated by packing, topical hemostatic agents, dressings, vessel ligation, laser beam coagulation, or embolization. Platelet transfusions are administered for hemorrhage secondary to severe platelet dysfunction or thrombocytopenia, but usually are not indicated if there is no bleeding, even though platelets may be as low as 10,000/microL. Bleeding due to thrombocytopenia that is refractory to random-donor platelets may respond to cross-matched compatible platelets, or to recombinant factor VIIa (rFVIIa). Fresh frozen plasma is indicated infrequently; bleeding due to coagulopathies is better managed with cryoprecipitate if fibrinogen is low, or with clotting factor concentrates appropriate for the specific clotting factors found to be deficient. rFVIIa or activated prothrombin complex concentrate usually controls hemorrhage due to autoantibodies directed against factor VIII, and acquired von Willebrand's disease may be responsive to desmopressin or intravenous gamma globulin infusion. Antifibrinolytic agents often enhance other hemostatic therapies, but should be withheld if there is genitourinary bleeding or evidence of disseminated intravascular coagulation. Finally, plasmapheresis and immunoadsorption to remove paraproteins may be helpful when other measures fail to curb bleeding.

Acute neurological signs as the predominant clinical manifestation in four dogs with Angiostrongylus vasorum infections in Denmark

“…Compromised blood supply to the area involved, along with direct physical compression caused by a haematoma makes the CNS, which is strongly dependent on continuous supplies of oxygen and glucose, highly susceptible to irreversible damage. Furthermore, any attempt of surgical decompression or evacuation of the haematoma is severely complicated by the presence of ongoing haemostatic dysfunction unless addressed appropriately by blood component therapy such as fresh frozen plasma or cryoprecipitate [35]. …”

Biomedical Optics and Lasers

“…When vascular pathologies of organ systems are considered, laser system with high coagulation effect can easily help the surgeon to remove vascular pathologies with lifethreatening bleeding risk more safely, due to its blood-stopping effect [46][47][48][49][50][51]. This feature of laser beam makes it a superior tool to scalpel when removal of lesions with high bleeding tendency [52] or surgical approaches of patients receiving anticoagulant therapy [53] or bleeding tendencies [54] are considered.…”

Bleeding in the patient with a malignancy

“…Theoretical mechanisms involved in the production of FVIII autoantibodies in patients with hematologic malignancies. 8 The abnormal leukemic clone or neoplastic B cells may mediate the generation of an abnormal FVIII molecule or other similar antigen by unknown mechanisms (1). Alternatively, there may be aberrations in the process of antigen presentation (2) or alterations in the number or function of CD-4þ cells or T-cell receptors (3).…”

“…Determining the etiology of bleeding in a patient with a malignancy can prove challenging, given the numerous potential causes in this particular patient population (Table 1). 1, 2 Bleeding may be attributable to conditions that preceded the diagnosis of cancer, to the malignancy itself, or to associated treatments. Disease‐related causes of bleeding include thrombocytopenia resulting from bone marrow infiltration or trauma to friable and/or highly vascularized malignant tissues.…”