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This chapter reviews key hematologic complications in malignancy, including coagulopathy, thrombosis, and hemolysis. Consumptive coagulopathy occurs in ~80% of acute promyelocytic leukemia (APL) cases at diagnosis, presenting with thrombocytopenia, low fibrinogen, and elevated prothrombin time (PT), partial prothrombin time (PTT), and D-dimers. Bleeding ranges from mild to life-threatening. The chapter also highlights pegasparaginase-related thrombosis, more common in adults, and outlines the management of low- and high-risk venous thrombo-embolism (VTE) in cancer patients. Anticoagulation may be withheld in low-risk cases with severe thrombocytopenia, while high-risk VTE requires full-dose anticoagulation with platelet support. Finally, hemolysis in myelodysplastic neoplasms is discussed as a recognized but under-characterized complication.

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Hemostasis Disturbances in Acute Leukemias and Myelodysplastic Neoplasms

  • 章节

  • 发表日期：

    2026年

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  • Talha Badar,
  • Syed Ali Abutalib,
  • Jean M. Connors

摘要

This chapter reviews key hematologic complications in malignancy, including coagulopathy, thrombosis, and hemolysis. Consumptive coagulopathy occurs in ~80% of acute promyelocytic leukemia (APL) cases at diagnosis, presenting with thrombocytopenia, low fibrinogen, and elevated prothrombin time (PT), partial prothrombin time (PTT), and D-dimers. Bleeding ranges from mild to life-threatening. The chapter also highlights pegasparaginase-related thrombosis, more common in adults, and outlines the management of low- and high-risk venous thrombo-embolism (VTE) in cancer patients. Anticoagulation may be withheld in low-risk cases with severe thrombocytopenia, while high-risk VTE requires full-dose anticoagulation with platelet support. Finally, hemolysis in myelodysplastic neoplasms is discussed as a recognized but under-characterized complication.