Disorders of hemostasis in acute leukemia: II

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Bleeding is a frequent complication in patients with acute leukemia. The most common cause of hemorrhage is thrombocytopenia. The incidence of serious and, at times, life threatening bleeding is high when the platelet count is below 10,000 cu mm, particularly when fever and infection are present. Patients with acute granulocytic leukemia and a white cell count above 100,000 cu mm have a high risk of intracranial hemorrhage, even in the presence of a normal platelet count. Platelet transfusion is effective in the treatment and prophylaxis of bleeding in leukemic patients with thrombocytopenia. Patients with sepsis often respond poorly to platelet transfusion. Patients who have been repeatedly transfused may become allosensitized and unresponsive to random platelet therapy. In such circumstances, transfusion of platelets from HL-A matched donors is more effective. Disseminated intravascular coagulation may complicate the course of acute leukemia. Patients with acute promyelocytic leukemia and all patients with AL and sepsis and uncontrollable disease are at special risk for development of this complication. The main therapeutic effort should be to control the infection and induce remission, if possible. Treatment with heparin may be helpful to tide such patients over a crisis period until more definite therapy can be initiated. Supportive care is essential. Transfusions with platelets, fresh frozen plasma and packed red cells is often required. Occasionally, other hemostatic defects such as clotting factors deficiency due to liver disease, vitamin K deficiency, platelet dysfunction or circulating anticoagulant may be present and require appropriate therapeutic measures.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalClinical Bulletin
Issue number2
StatePublished - Dec 1 1975

All Science Journal Classification (ASJC) codes

  • General Medicine


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