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
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.