Thrombotic and hemorrhagic strokes complicating early therapy for childhood acute lymphoblastic leukemia.
Sudden cerebrovascular insults occurred during or immediately following remission induction therapy in 4 children with acute lymphoblastic leukemia. In 3, cerebral infarction was due to thrombosis. In the fourth, an intracerebral hematoma developed representing either frank hemorrhaging or a hemorrhagic infarction. None of the patients had central nervous system leukemia or extreme leukocytosis at the time of diagnosis. Symptoms were obtundation, hemiparesis, seizures, and headache. The induction chemotherapy included L-asparaginase which causes deficiencies of antithrombin, plasminogen, fibrinogen, and factors IX and XI. These hemostatic abnormalities may explain the thromboses and bleeding observed in these children.
D000293:Adolescent; D001215:Asparaginase / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D002544:Cerebral Infarction / Q000209:etiology; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000139:chemically induced*; D007945:Leukemia, Lymphoid / Q000150:complications* / Q000188:drug therapy; D008297:Male; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D001215:Asparaginase