Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization

American Journal of Hematology
John T PhelanPeter A Kouides

Abstract

Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, epsilon-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/microL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting.

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Citations

Jul 15, 2009·Journal de gynécologie, obstétrique et biologie de la reproduction·H RomanL Marpeau
Dec 21, 2013·The Permanente Journal·Malcolm G Munro, UNKNOWN Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group
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May 1, 2007·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Alexander M Quaas, Elizabeth S Ginsburg
Feb 16, 2016·Journal of Pediatric and Adolescent Gynecology·Madhvi RajpurkarMeera Chitlur

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