Clinical and Pathologic Studies of Gastrointestinal Hemorrhage in Acute Leukemia

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Abstract
Cases (160) of acute leukemia observed between 1953-1977 were reviewed as to the presence and nature of the accompanying gastrointestinal hemorrhage. A massive gastrointestinal hemorrhage requiring blood transfusions occurred in 29 cases (18%). The most common lesion was hemorrhagic necrosis of the small intestines. There were 3 forms of hemorrhage. Type I was characterized by: thrombocytopenia, hemorrhagic diathesis and diffuse hemorrhage of mucosa and submucosa, but no erosion nor ulceration. Type II exhibited no specific pathologic findings. Diffuse hemorrhage, superficial erosions, bacterial and fungal invasions were observed. Type III was characterized by single and/or multiple ulcerations, necrosis and perforation of the small intestines and colon. Thrombocytosis was almost always present at the prebleeding phase in these cases. Intravascular microthrombi at the basis of ulceration were seen. Usually, more than 1 process was seen in each case. An appropriate approach to the severe gastrointestinal hemorrhage with a combination of anti-leukemic chemotherapy, anticoagulant therapy, platelet transfusion, etc. would further add to the number of long-term survivors in acute leukemia.

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