Acute cerebral infarct with elevated factor VIII level during the thrombocytopenic stage after hematopoietic stem cell transplant.
Thromboembolism is a complication of hematopoietic stem cell transplant. However, a literature search showed no previous reports of cerebral infarction during the thrombocytopenic stage after hematopoietic stem cell transplant. A 35-year-old woman with acute lymphoblastic leukemia (precursor B-cell type) was treated with hematopoietic stem cell transplant after induction and consolidation chemotherapy. On day 2 after transplant, she was unconscious, and had urinary incontinence and left hemiplegia. A computed tomography scan of the brain showed an acute ischemic infarct in the right middle cerebral artery region and an old infarct at the left thalamus without atherosclerosis. Factor VIII level was elevated (190%; normal range, 60% to 150%). She was treated with rehabilitation and low-dose aspirin. At 6 months after transplant, the leukemia remained in remission and she had no further thromboembolic events. This case suggests that prudent treatment of patients who have hematopoietic stem cell transplant may include monitoring for thromboembolism and testing factor VIII level before transplant.
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hui-Hua
HH
Hsiao
Hung-Ling
HL
Huang
Hui-Ching
HC
Wang
Yu-Fen
YF
Tsai
Ta-Chih
TC
Liu
Chao-Sung
CS
Chang
Sheng-Fung
SF
Lin
D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D015854:Up-Regulation
D015415:Biomarkers; C078147:F8 protein, human; D005169:Factor VIII