title: Severe disseminated coagulopathy caused by adenocarcinoma with bone marrow metastasis.
abstract: BACKGROUND
  Patients with mucin-producing adenocarcinoma have an increased risk for venous and arterial thrombosis. When these patients present with thrombocytopenia, disseminated intravascular coagulopathy (DIC) is often the underlying cause.
  
  
  METHODS
  We report 2 patients who were admitted due to bleeding symptoms of unknown cause, in whom further workup revealed adenocarcinoma-induced DIC.
  
  
  CONCLUSIONS
  In elderly patients presenting with signs of DIC, such as reduced fibrinogen levels, elevated prothrombin time, elevated D-dimer, and thrombocytopenia, without any obvious reason (e.g., sepsis), adenocarcinoma-associated coagulopathy should be considered as the underlying cause. Paradoxically, in these patients bleeding symptoms improve when the patient is sufficiently anti-coagulated with low molecular weight heparin. Treatment of the underlying disease is of central importance in controlling acute or chronic DIC associated with malignant diseases and chemotherapy should be started as soon as possible.
authors.affiliation: Department of Hematology/Oncology, Ernst-Moritz-Arndt University Greifswald, Germany. klenner@uni-greifswald.de
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klenner
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
authors.forename: Anna
authors.initials: A
authors.lastname: Kuvikova
authors.forename: Gottfried
authors.initials: G
authors.lastname: Dölken
authors.forename: Christoph
authors.initials: C
authors.lastname: Busemann
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000188:drug therapy / Q000556:secondary*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D019046:Bone Marrow Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000556:secondary*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications* / Q000188:drug therapy; D008297:Male; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants