Disorders of hemostasis in acute leukemia. I

Bleeding is a major and at times catastrophic complication of acute leukemia (AL). In the untreated disease, hemorrhage occurs in approximately 75% of the patients at some time during the course of their short survival. Is is slightly more common in patients with acute lymphoblastic than in patients with acute myelogenous leukemia. Bleeding as a cause of death in AL has been significantly reduced since the introduction of platelet transfusion in the management of such patients. There are many underlying causes of hemorrhage in AL. The most frequent and the most important single factor is thrombocytopenia. Other defects in hemostasis such as clotting factor deficiencies, the occurrence of disseminated intravascular coagulation (DIC), abnormal fibrinolysis and impaired vascular integrity may also play a significant role. In this paper, the occurrence and pathogenesis of various defects in hemostasis and their contribution to bleeding in patients with AL are reviewed and possible methods of management discussed. (32 references)