title: Acute compartment syndrome as the initial manifestation of chronic-phase chronic myeloid leukemia: a case report and review of the literature.
abstract: BACKGROUND
  Acute compartment syndrome is an orthopedic emergency requiring urgent fasciotomy to prevent irreversible damage. In hematological malignancies, acute compartment syndrome caused by severe soft tissue bleeding is extremely rare. We present a patient with chronic-phase chronic myeloid leukemia who had acute compartment syndrome caused by severe soft tissue bleeding in her right forearm.
  
  
  METHODS
  A 72-year-old Japanese woman was referred to our hospital with swelling and pain of her right forearm without a previous history of trauma. She was diagnosed with chronic-phase chronic myeloid leukemia. Extreme thrombocytosis was present, although no evidence of acquired von Willebrand disorder was found. Compartment syndrome caused by soft tissue bleeding was confirmed. An emergency fasciotomy for decompression was conducted. However, sustained postoperative bleeding occurred and required massive red cell concentrate transfusion. As her platelet count decreased by cytoreductive therapy, complete hemostasis was achieved.
  
  
  CONCLUSIONS
  Patients with an extremely high platelet count might be at high risk for severe bleeding complications even without acquired von Willebrand disease. For the control of severe bleeding complications in patients with myeloproliferative disorder, the importance of thrombocyte reduction should be recognized.
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nagase
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan. ueda0904@hp.pref.hyogo.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Matsunaga
authors.affiliation: Department of Clinical Laboratory, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Machida
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakata
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Fuka
authors.initials: F
authors.lastname: Mima
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Risato
authors.initials: R
authors.lastname: Takeda
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hayashi
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Sadaharu
authors.initials: S
authors.lastname: Iio
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Okita
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Narahara
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yasunaga
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inui
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
authors.forename: Sumio
authors.initials: S
authors.lastname: Kawata
mesh_terms: D000208:Acute Disease; D000368:Aged; D003161:Compartment Syndromes / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D019299:Decompression, Surgical; D000071938:Fasciotomy / Q000379:methods; D005260:Female; D005542:Forearm / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000503:physiopathology*
keywords: Acute compartment syndrome; Bleeding complications; Chronic myeloid leukemia; Thrombocytosis