Hypofibrinogenemic Hemorrhage in Acute Myelogenous Leukemia Treated with Heparin

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Abstract
A case of acute myelogenous leukemia with a severe hemorrhagic diathesis was studied. The coagulation profile was characterized by a profound hypofibrinogenemia factor V and factor VIII deficiency, and thrombocytopenia. There was no laboratory evidence of primary fibrinolysis. These results suggested the strong possibility of a defibrination syndrome secondary to intravascular clotting. The patient was given a course of heparin therapy which was associated with transient but substantial rise in fibrinogen levels. A second course of heparin given during the preterminal stage of the illness was not helpful, presumably due to severe liver disease. Autopsy studies revealed evidence of widespread intravascular coagulation. Fibrin thrombi were present within the lumina of the vessels of virtually every organ and there were infarctions in the brain, liver and kidney. This case illustrates the paradoxical clinical state of hemorrhage occurring on the heels of widespread intravascular coagulation with secondary depletion of clotting factors.