title: Chemotherapy-associated oral hemorrhages in adults with acute leukemia.
abstract: The frequency, nature, and management of chemotherapy-associated oral hemorrhages were studied in 1,093 adult inpatients undergoing treatment for acute leukemia or the blastic phase of chronic leukemia. Of this number, 163 (14.9%) manifested gross bleeding from the mouth during the course of treatment. The most common oral bleeding sites were the lips, tongue, and gingiva. Thrombocytopenia was the underlying cause in 88% of the cases, disseminated intravascular coagulation in 6%, and combinations of thrombocytopenia and hypofibrinogenemia and of thrombocytopenia and vitamin K deficiency in 5.5% and 0.6%, respectively. The vast majority of the patients with mouth bleeding had platelet counts below 40,000/mm3. Approximately 50% had indirect evidence of a coagulation factor deficiency in the blood. The oral hemorrhages were best managed by transfusions of HLA-compatible fresh platelets and fresh frozen plasma, together with topically applied clot-promoting agents, until hemostatic control was restored.
mesh_terms: D000208:Acute Disease; D000328:Adult; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D006472:Oral Hemorrhage / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D013921:Thrombocytopenia / Q000209:etiology