Blood Malignancies and Treatment

Biography

Biography: John Batchelor

Abstract

Spontaneous intracranial haemorrhage is a well recognised complication in patients with haematological disease. Intracranial haemorrhage is the second leading cuase of death in patients with acute myeliod leukaemia. The reported mortality is over 50% for patients with haematological malignancy and spontaneous intracranial haemorrhage. The reported incidence of spontaneous intracranial haemorrhage appears to be slightly higher in acute myeliod leukaemia (AML) and chronic myeloid leukaemia in blast crisis than in other forms of haemalogical malignancy. The distribution of ICH is as follows:- intraparenchymal haemorrhage accounts for about 60% of the reported case series. The remaining sites are distributed between the cerebellum, brainstem, basal ganlia, subarachnoid, subdural, intraventricular and epidural regions. Over 50% of patients will having more than one intracranial bleeding site on CT. Previously proposed risk factors for spontaneous intracranial bleeding include: direct invasion by tumour cells, invasive intracranial sepsis, hyperleukocytosis, and coagulopathy. Abnormalities of clotting include DIC, thrombocytopenia and pronlonged prothrombin time. Coagulopathy and thrombocytopenia are probably not the main factors reponsible for spontaneous intracranial haemorrhage in view of the fact that neither platelets nor clotting factors are responsible for maintianing cerebral vessel integrity under normal physiological conditions. Cohort studies from patients with idiopathic thrombocytopenia have shown a poor correlation between platelet count and the risk of spontaneous intracranial haemorrhage in both adults and children. Batchelor (2015) has shown that coagulopathy in patients with traumatic intracranial bleeding increases the risk of progressive haematoma progression by an odds ratio of 6.176 (95% CI: 4.727 – 8.069). This paper aims to explore other factors which may account for spontaneous ICH in patients with haematological malignancy .