[Severe hemorrhage in a patient with metastatic colorectal cancer -  case 8/2012].
METHODS
We report on a 65-year-old female patient with a recent diagnosis of adenocarcinoma of the sigmoid colon and massive hematochezia in the context of a general bleeding disorder.


METHODS
Disseminated malignant disease with hepatic metastases as well as bone marrow involvement was demonstrated. Moreover, circulating tumor cells were demonstrated by flow cytometry. The patient had right lower quadrant abdominal pain due to a spontaneous psoas intramuscular hematoma.


METHODS
At the time of admission to our hospital, the patient displayed microangiopathic hemolytic anemia and secondary hyperfibrinolysis with a pronounced bleeding tendency. Moreover, there was an acute renal failure which improved with fluid resuscitation. With immediate chemotherapy consisting of 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX regimen) and cetuximab initiated with the second course, plasmatic coagulation could be stabilized. Consequently, treatment with tranexamic acid, fibrinogen, fresh frozen plasma as well as red blood cell and platelet infusions could be stopped. Continuation of chemotherapy was possible on an outpatient basis and the further course was associated with a good quality of life until her near end. The patient died at home 7 months after initial diagnosis of her colon cancer due to progressive disease with CNS metastases.


CONCLUSIONS
Disseminated intravascular coagulation with microangiopathic hemolysis and secondary hyperfibrinolysis is a rare albeit possible event in disseminated colorectal cancer, especially when the bone marrow is involved. Treatment of the underlying cause is the most important therapeutic measure.
Medizinische Klinik, Universitätsklinikum Tübingen.
Melanie
M
Orgel
Marius
M
Horger
Ralph
R
Kurth
Lothar
L
Kanz
Karl
K
Jaschonek
Frank
F
Mayer
Hans-Georg
HG
Kopp
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D019046:Bone Marrow Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary; D000068818:Cetuximab; D018450:Disease Progression; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology; D006474:Hemorrhagic Disorders / Q000209:etiology*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary*; D009360:Neoplastic Cells, Circulating; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010166:Palliative Care; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis / Q000209:etiology; D012187:Retroperitoneal Space; D012811:Sigmoid Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil