title: Gastrointestinal bleeding in a chronic myeloid leukaemia patient precipitated by dasatinib-induced platelet dysfunction: Case report.
abstract: Bleeding in patients with chronic myeloid leukaemia (CML) receiving the second-line tyrosine kinase inhibitor (TKI) dasatinib is a well-documented side effect, occurring in up to 24% of patients. In most cases, it is attributed directly to a secondary grade 3 or 4 thrombocytopaenia. Platelet dysfunction precipitated by dasatinib has been demonstrated in multiple in vitro and in vivo studies; however, there is currently no correlative data that definitively associates this with clinically significant bleeding. In this case, we report a patient with chronic-phase CML receiving dasatinib who developed significant gastrointestinal bleeding secondary to angiodysplasia in the absence of a severe thrombocytopaenia or coagulopathy. Platelet function testing on the PFA-100 assay and formal platelet aggregometry demonstrated impaired platelet aggregation, however, upon cessation of dasatinib, platelet function normalised and the bleeding resolved without further intervention. This case demonstrates that dasatinib-induced platelet dysfunction can cause clinically significant bleeding and highlights the need for physicians to be aware of this adverse effect.
authors.affiliation: a Division of Cancer, Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Kostos
authors.affiliation: a Division of Cancer, Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Burbury
authors.affiliation: a Division of Cancer, Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Srivastava
authors.affiliation: a Division of Cancer, Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
mesh_terms: D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects*; D000069439:Dasatinib / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy; D010979:Platelet Function Tests; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000069439:Dasatinib
keywords: Bleeding; chronic myeloid leukaemia; dasatinib; platelet-dysfunction