Thrombotic complications in patients with hematological malignancies based on autopsy data
DOI:
https://doi.org/10.14739/2310-1237.2019.2.177192Keywords:
hematologic malignancies, thrombosis, pulmonary embolism, autopsy, pathologyAbstract
The aim was to study the features of thrombosis and thromboembolism in the deceased patients with hematological malignancies, their relationship with underlying diseases and role in the development of lethal outcomes.
Materials and methods. The autopsy records of 60 patients with hematological malignancies and thrombotic complications died during the period of 25 years (1987–2011) in Lviv were reviewed. The following data were obtained: age, sex, postmortem pathological patterns, locations of thrombi, and associated underlying diseases. Frequency tables were obtained by the Fisher's exact test.
Results. The median age was 58 years old. There were 36 males and 24 females. Lymphoid neoplasms were diagnosed in 43 cases, myeloid neoplasms in 16 cases and mixed-phenotype acute leukemia in the one case. Venous thromboembolism predominated over arterial one (60 % vs 17 %, P < 0.001), and thrombi in heart chambers were detected in 8 % of cases. Thrombotic complications were the direct cause of death in 45 % of patients. Thrombosis was diagnosed in vivo only in 35 % of patients. In deceased with lymphoid neoplasms, in comparison with cases of myeloid neoplasms, pulmonary embolism was more common (65 % vs 25 %, P < 0.01), as well as local thrombi in small vessels (51 % vs 19 %, P < 0.05), which were associated with necrotic changes in tumors in 37 % of cases. Surgical interventions were performed during a two-week period before lethal outcomes in 33 % of patients with lymphoid neoplasms.
Conclusions. Thrombosis and thromboembolism in patients with hematologic neoplasms often causes a lethal outcome, in particular, due to frequent undiagnosed cases. Lymphoid neoplasms are the high risk factor for venous thromboembolism and local thrombosis of small vessels. Surgical operations are the weighry factor of thrombotic risk in such patients.
References
Mahajan, A., Wun, T., Chew, H., & White, R. H. (2014). Lymphoma and venous thromboembolism: influence on mortality. Thromb Res, 133(2), S23–28. doi: 10.1016/S0049-3848(14)50004-7
Falanga, A., Marchetti, M., & Russo, L. (2012). Venous thromboembolism in the hematologic malignancies. Curr Opin Oncol, 24(6), 702–710. doi: 10.1097/CCO.0b013e3283592331
Colombo, R., Gallipoli, P., & Castelli, R. (2014). Thrombosis and hemostatic abnormalities in hematological malignancies. Clin Lymphoma Myeloma Leuk, 14(6), 441–450. doi: 10.1016/j.clml.2014.05.003
Shaboodien, R., Stansby, G., Hunt, B. J., & Agarwal, R. (2012). Unprovoked venous thromboembolism: assess for cancer. Lancet Oncol, 13(10), 973–974. doi: 10.1016/S1470-2045(12)70415-1
Sant, M., Allemani, C., Tereanu, C., De Angelis, R., Capocaccia, R., Visser, O., et al. (2010). Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood, 116(19), 3724–3734. doi: 10.1182/blood-2010-05-282632
Chong, B. H., & Lee, S. H. (2007). Management of thromboembolism in hematologic malignancies. Semin Thromb Hemost, 33(4), 435–448. doi: 10.1055/s-2007-976179
Khorana, A. A., Francis, C. W., Culakova, E., Fisher, R. I., Kuderer, N. M., & Lyman, G. H. (2006). Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol, 24(3), 484–490. doi: 10.1200/JCO.2005.03.8877
Khorana, A. A., & Connolly, G. C. (2009). Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol, 27(29), 4839–4847. doi: 10.1200/JCO.2009.22.3271
Wang, L. M., Duan, Q. L, Yi, X. H., Zeng, Y., Gong, Z., & Yang F. (2014). Venous thromboembolism is a product in proliferation of cancer cells. Int J Clin Exp Med, 7(5), 1319–1323.
Salvano, L., Burgüesser, B., Diller, A., Garzon, M. I., Amuchastegui, T., Caeiro, E., & Orozco, S. (2011). 26 year-old male patient with bone marrow transplantation. Report of a partial autopsy. Rev Fac Cien Med Univ Nac Cordoba, 68(1), 33–38.
Pfeiler, S., Massberg, S., & Engelmann, B. (2014). Biological basis and pathological relevance of microvascular thrombosis. Thromb Res, 133(1), S35–37. doi: 10.1016/j.thromres.2014.03.016
Reddel, C. J., Tan, C. W., & Chen, V. M. (2019). Thrombin Generation and Cancer: Contributors and Consequences. Cancers (Basel), 11(1), 100. doi: 10.3390/cancers11010100
Dzis, I. Y., Vyhovska, Y. I., Tomashevska, O. Y., & Dzis, Y. I. (2015). Koahuliatsiini y zapalni markery yak predyktory trombozu v patsiientiv z limfoproliferatyvnymy khvorobamy [Coagulation and Inflammatory Markers as Predictors of Thrombosis in Patients with Lymphoproliferative Diseases]. Visnyk problem biolohii i medytsyny, 3(2), 116–121. [in Ukrainian].
Samura, B. B. (2017). Doslidzhennia prohnostychnoi znachushchosti prozapalnoi aktyvatsii u vynyknenni kardiovaskuliarnykh podii pislia likuvannia khronichnoi limfoidnoi leikemii [Predictive value of proinflammatory activation in prognosis of cardiovascular events after treatment of chronic lymphoid leukemia]. Zaporozhye medical journal, 19(3), 282–286. doi: 10.14739/2310-1210.2017.3.100614 [in Ukrainian].
Parkhomenko, O. M. (2015). Profilaktyka venoznykh tromboziv i embolij u patsientiv terapevtychnoho profiliu: suchasnyi stan problemy, mozhlyvi shliakhy yii vyrishennia v Ukrayini. Rezultaty proektu «Terytoriya bezpeky» [The prevention of venous thrombosis and embolism in non-surgical patients: the current state of the problem, possible solutions in Ukraine. Results of the project «Territory of Safety»]. Ukrayinskyi kardiolohichnyi zhurnal, 5, 110–125. [in Ukrainian].
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
