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/μL. 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.
KEYWORDS
Hematologic malignancies - bleeding - hemostasis - blood products - platelets
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David GreenM.D. Ph.D.
676 North St. Clair Street
Suite 850, Chicago, IL 60611
Email: d-green@northwestern.edu
