Hemorrhagic complications in patients with advanced hematological malignancies followed at home: an Italian experience.
Patients with advanced hematological malignancies may experience many troublesome hemorrhagic complications requiring hospitalisation during a palliative home care (HC) program. We report on the feasibility of the management of bleeding at home in patients with haematological malignancies admitted in a domiciliary HC program. The occurrence of a major hemorrhage episode (>1 WHO grade) was registered among 469 patients with hematological malignancies in the terminal phase of their disease followed at home. Number, sites, domiciliary treatment (local hemostatic measures, platelet units, hemostatic drugs, packed red blood cells) and outcome of hemorrhagic complications were evaluated. Out of 469 patients, 123 (26%) experienced a bleeding complication; the overall number of hemorrhagic episodes was 232 (49%) with a median number of 2 episodes per patient. Patients with a platelet count lower than 20 x 10(9)/L (P < 0.00005) or with a diagnosis of acute leukemia or in blast crisis of myeloprolypherative disorders (P < 0.00005) showed a significant higher incidence of hemorrhages than other patients. Resolution of bleeding at home was obtained in 206 (88%) of the 232 episodes; platelet units were transfused at home in 188 (81%) cases. Bleeding was the cause of hospitalisation in four cases. Death occurred in 447 of 469 patients: in 26 of them (6%), it was caused by bleeding complications (11 brain hemorrhage, 2 hematemesis, 3 hemoptysis and 10 melena). In this group of patients, bleeding was a relevant clinical problem However, by implementing a domiciliary palliative care program, home management of hemorrhages proved to be a safe and effective choice.
Cartoni
Claudio
C
Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, University Sapienza, Rome, Italy.
Niscola
Pasquale
P
Breccia
Massimo
M
Brunetti
Gregorio
G
D'Elia
Gianna Maria
GM
Giovannini
Marco
M
Romani
Claudio
C
Scaramucci
Laura
L
Tendas
Andrea
A
Cupelli
Luca
L
de Fabritiis
Paolo
P
Foa
Robin
R
Mandelli
Franco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult