Complications and Management of Coagulation Disorders in Leukemia Patients

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the ONA take:

Coagulative disorders — such as thromboembolism and thrombocytopenia — in patients with leukemia is complicated not only in pathophysiology but also in management. In this review, the authors attempt to reconcile the differences in knowledge between hematologists and leukemia specialists.

The authors present a series of case studies of patients with varying subtypes of leukemia, providing history, clinical features, and specific laboratory test values. By providing the epidemiology, pathophysiology, and methods used, they attempt to elucidate the rationale and process of specific treatment modalities.

The review covers case studies of GK, a 39-year-old woman with pre-B-Cell acute lymphoblastic leukemia, whose super sagittal sinus thrombosis led to tonic-clonic seizures and right-sided hemiparesis; RM, a 28-year-old woman with acute myeloid leukemia who presented with arterial thrombosis; coagulation disorders in MS, a 19-year-old man with myeloproliferative neoplasm who had thrombosis of the splenoportal axis; and HK, a 62-year-old woman with chronic lymphocytic leukemia who developed grade 3 thrombocytopenia.

As evidenced by these case studies, coagulation disorders are common and highly varied in patients with leukemia and may range from thrombotic events to hemorrhage. The authors concluded that “we need better predictors and coagulation tests to identify such patients. More research with prospective randomized control studies is needed on the role of novel oral anticoagulants, anticoagulant choice, dosing, and duration in hematologic malignancies.”

Complications and Management of Coagulation Disorders in Leukemia Patients
Complications and Management of Coagulation Disorders in Leukemia Patients

Abstract: Patients with leukemia are predisposed to various coagulation abnormalities. Thrombosis and bleeding continue to be a major cause of morbidity and mortality in leukemias. The pathophysiology of these disorders is unique, and not only the disease but also the treatment and other factors play a role. There has been an increase in the understanding of these disorders in leukemias. However, it is still difficult to predict when and which patients will have these complications. The evidence for the management of coagulation abnormalities in leukemias is still evolving and not as established as in solid malignancies. The management of these disorders is complex, and making clinical decisions is often challenging. In the era of specialization, where there are different hematologists looking after benign- and malignant-hematology patients, opinions of thrombosis experts are often sought by leukemia specialists. This review aims to bridge the gap in the knowledge of these disorders between these specialists.


Keywords: leukemia, coagulation, thrombosis, bleeding 

INTRODUCTION

Coagulation disorders are common in leukemia patients. The incidence of thromboembolism (TE) in hematologic malignancies (including lymphoma and myeloma) stands at 4% per year. This is the fourth most common cause after pancreatic (11%), brain (8%), and lung cancers (4.4%).1 The incidence of bleeding is the highest of all malignancies by virtue of the disease-related thrombocytopenia itself. Coagulation disorders seen in lymphoma, myeloma, and other solid malignancies are beyond the scope of this review. The reader may refer to excellent reviews and guidelines on these topics.2,3 For the purpose of simplicity, we deal with each leukemia type with a case vignette, followed by epidemiology, pathophysiology, and management issues. All patients provided written informed consent for their case details to be published.  

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