Hemostatic complications in bone marrow transplantation: a retrospective analysis of 447 patients.
BACKGROUND
Hemostatic complications are not uncommon after bone marrow transplantation (BMT). However, little is known about the frequency, localization, determinants, and outcome of hemostatic events in autologous and allogeneic BMT.


METHODS
Four hundred forty-seven patients (364 allogeneic, 83 autologous transplants) were evaluated retrospectively for the presence of hemostatic complications (bleeding, thrombosis, hepatic veno-occlusive disease [VOD], microangiopathic hemolytic anemia) from the start of conditioning therapy until June 2000.


RESULTS
A total of 83.2% of the patients presented with at least one hemostatic complication during the investigational period. Most bleeding episodes occurred within the first 4 weeks after transplantation and were relatively mild. However, 27.1% of the patients hemorrhaged severely, generally doubling the overall mortality of the BMT recipients. Fatal gastrointestinal or intracerebral hemorrhages contributed to 1.1% of the events. Bleeding was strongly associated with prolonged thrombocytopenia and graft-versus-host disease (GVHD). Hemorrhagic cystitis may additionally have been triggered by the preceding conditioning regimens containing cyclophosphamide. Thromboembolic events occurred most frequently in allogeneic transplant recipients, for whom the incidence was 14.6%. Chronic GVHD and treatment with steroids were the major determining factors. The incidence of hepatic VOD in 4.7% of the allogeneic transplant recipients was associated with a high fatality rate. Busulfan conditioning increased the VOD risk 2.6-fold. Moderate or severe microangiopathic hemolytic anemia was associated with GVHD and occurred in 14.6% of the allogeneic transplant recipients, leading to an increased overall mortality.


CONCLUSIONS
Hemostatic disturbances, commonly found in the course of transplantation, are associated with a high transplantation risk and closely related to thrombocytopenia and immunologic complications.
Pihusch
Rudolf
R
Medizinische Klinik III-Grobetahadern, Klinikum der Ludwig Maximilians-Universität München, München, Germany. Rudolf.Pihusch@t-online.de.
Salat
Christoph
C
Schmidt
Edwin
E
Göhring
Peter
P
Pihusch
Markus
M
Hiller
Erhard
E
Holler
Ernst
E
Kolb
Hans-Jochem
HJ
D000293:Adolescent; D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000503:physiopathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D006470:Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology* / Q000503:physiopathology; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous / Q000009:adverse effects
D007166:Immunosuppressive Agents