There are many situations in which bleeding occurs in patients with leukemia. The more common ones are observable bleeding, such as epistaxis, epistaxis, scleral bleeding, and mucosal petechiae on the skin; there are others that are not observable from the surface of the patient, such as gastrointestinal bleeding or even intracranial bleeding, and these often have serious consequences, with a significant proportion of patients dying as a result. Therefore bleeding in leukemia patients is a growing concern.
What are the causes of bleeding?
- On the one hand, because there is a large proliferation of leukemic cells in the patient’s bone marrow, and therefore a corresponding decrease in platelet-producing megakaryocytes, there are fewer platelets involved in clotting, which affects thrombogenesis. Patients undergoing chemotherapy will have a period of myelosuppression, with low white blood cells, red blood cells, and platelets, and will also be prone to bleeding.
- In addition, certain acute leukemias such as acute promyelocytic leukemia, where the destruction of tumor cells releases large amounts of asplenophilic granules that deplete blood clotting factors and promote fibrinolysis, leading to diffuse intravascular coagulation, can also manifest clinically with widespread uncorrectable bleeding and very high mortality.
- There are also patients with leukemia with high leukocyte load, where leukemic cells infiltrate extensively in the body, involving not only the liver, spleen, and other substantial organs, but also infiltrating the vessel walls, disrupting their integrity and affecting their contractile function, leading to severe bleeding manifestations.
So bleeding in leukemia is mainly ameliorated by treating the primary disease and giving symptomatic supportive therapy such as component transfusions; nevertheless, it is still a very serious complication with high mortality and requires high attention from patients and their families.