Clinical outcome of leukemia patients with intracranial hemorrhage

Clinical article

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Object

Intracranial hemorrhage (ICH) is a frequent complication found in leukemia patients with thrombocytopenia. At the University of Texas MD Anderson Cancer Center, when a leukemia patient is found to have ICH, a platelet transfusion is generally recommended until 50,000/μl is reached. The authors examine the feasibility and outcome of their intervention strategy in this study.

Methods

Records were reviewed from 76 consecutive leukemia patients with newly diagnosed ICH at the University of Texas MD Anderson Cancer Center from January 1, 2007, to December 31, 2009. Variables of interest included age, platelet count at presentation, leukemia subtype, history of trauma, Glasgow Coma Scale score at presentation, whether the 50,000/μl goal was reached after transfusion, and whether the patient was a transfusion responder (platelet count increase > 2000/μl/unit transfused). Outcome parameters were mortality rates at 72 hours and 30 days and imaging-documented hemorrhage progression.

Results

Thrombocytopenia was prevalent at the time of presentation (68 of 76 patients had platelet levels < 50,000/μl at presentation). Despite an aggressive transfusion protocol, only 24 patients reached the 50,000/μl target after an average of 16 units of transfusion. Death due to ICH occurred in 15 patients within the first 72 hours (mortality rate 19.7%). Death correlated with the presenting Glasgow Coma Scale score (p = 0.0075) but not with other transfusion-related parameters. A significant mortality rate was again observed after 30 days (32.7%). The 30-day mortality rate, however, was largely attributable to non-ICH related causes and correlated with patient age (p = 0.032) and whether the patient was a transfusion responder (p = 0.022). Reaching and maintaining a platelet count > 50,000/μl did not positively correlate with the 30-day mortality rate (p = 0.392 and 0.475, respectively).

Conclusions

Platelet transfusion in the setting of ICH in leukemia patients is undoubtedly necessary, but whether the transfusion threshold should be 50,000/μl remains unclear. Factors other than thrombocytopenia likely contribute to the overall poor prognosis.

Abbreviations used in this paper: GCS = Glasgow Coma Scale; ICH = intracranial hemorrhage; SDH = subdural hematoma.

Article Information

Address correspondence to: Andrew J. Tsung, M.D., Department of Neurosurgery, Illinois Neurological Institute, UICOMP, 530 NE Glen Oak, Peoria, Illinois 61637. email: andrew.j.tsung@ini.org.

Please include this information when citing this paper: published online May 13, 2011; DOI: 10.3171/2011.4.JNS101784.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing the cause and number of deaths in the study. Pink line = ICH-related deaths, blue line = all deaths.

References

  • 1

    Bayer WLBodensteiner DCTilzer LLAdams ME: Use of platelets and other transfusion products in patients with malignancy. Semin Thromb Hemost 18:3803911992

    • Search Google Scholar
    • Export Citation
  • 2

    Bishop JFSchiffer CAAisner JMatthews JPWiernik PH: Surgery in acute leukemia: a review of 167 operations in thrombocytopenic patients. Am J Hematol 26:1471551987

    • Search Google Scholar
    • Export Citation
  • 3

    Gaydos LAFreireich EJMantel N: The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med 266:9059091962

    • Search Google Scholar
    • Export Citation
  • 4

    Gmür JBurger JSchanz UFehr JSchaffner A: Safety of stringent prophylactic platelet transfusion policy for patients with acute leukaemia. Lancet 338:122312261991

    • Search Google Scholar
    • Export Citation
  • 5

    González-Duarte AGarcía-Ramos GSValdés-Ferrer SICantú-Brito C: Clinical description of intracranial hemorrhage associated with bleeding disorders. J Stroke Cerebrovasc Dis 17:2042072008

    • Search Google Scholar
    • Export Citation
  • 6

    Graus FRogers LRPosner JB: Cerebrovascular complications in patients with cancer. Medicine (Baltimore) 64:16351985

  • 7

    Heckman KDWeiner GJDavis CSStrauss RGJones MPBurns CP: Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL. J Clin Oncol 15:114311491997

    • Search Google Scholar
    • Export Citation
  • 8

    Kantarjian HGiles FList ALyons RSekeres MAPierce S: The incidence and impact of thrombocytopenia in myelodysplastic syndromes. Cancer 109:170517142007

    • Search Google Scholar
    • Export Citation
  • 9

    Kim HLee JHChoi SJLee JHSeol MLee YS: Risk score model for fatal intracranial hemorrhage in acute leukemia. Leukemia 20:7707762006

    • Search Google Scholar
    • Export Citation
  • 10

    Norfolk DRAncliffe PJContreras MHunt BJMachin SJMurphy WG: Consensus Conference on Platelet Transfusion, Royal College of Physicians of Edinburgh, 27–28 November 1997. Synopsis of background papers. Br J Haematol 101:6096171998

    • Search Google Scholar
    • Export Citation
  • 11

    National Institutes of Health Consensus Conference: Platelet transfusion therapy. Transfus Med Rev 1:1952001987

  • 12

    Rebulla PFinazzi GMarangoni FAvvisati GGugliotta LTognoni G: The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med 337:187018751997

    • Search Google Scholar
    • Export Citation
  • 13

    Schiffer CAAnderson KCBennett CLBernstein SElting LSGoldsmith M: Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:151915382001

    • Search Google Scholar
    • Export Citation
  • 14

    Trial to Reduce Alloimmunization to Platelets Study Group: Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med 337:186118701997

    • Search Google Scholar
    • Export Citation
  • 15

    Wandt HFrank MEhninger GSchneider CBrack NDaoud A: Safety and cost effectiveness of a 10 x 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 x 10(9)/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood 91:360136061998

    • Search Google Scholar
    • Export Citation

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