MACULAR HAEMORRHAGE IN ADULT ACUTE LEUKAEMIA PATIENTS AT PRESENTATION AND THE RISK OF SUBSEQUENT INTRACRANIAL HAEMORRHAGE

• Published in: British journal of haematology Vol. 98; no. 1; pp. 204 - 209
• Main Authors: Jackson, Nicholas, Reddy, Sagili Chandrasekhara, Harun, Mohd Hishamuddin, Quah, Soon Hoe, Low, Heng Chin
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.07.1997; Blackwell
• Subjects: acute leukaemia; Adolescent; Adult; Aged; Biological and medical sciences; Blood Cell Count; Blood Coagulation Disorders - etiology; Cerebral Hemorrhage - etiology; Female; Hematologic and hematopoietic diseases; Humans; intracranial haemorrhage; Leukemia, Myeloid - complications; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Macula Lutea; Male; Medical sciences; Middle Aged; Partial Thromboplastin Time; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Prothrombin Time; retina; retinal haemorrhage; Retinal Hemorrhage - etiology; Retrospective Studies; Human; Intracranial; Nervous system diseases; Retinopathy; Acute; Leukemia; Cardiovascular disease; Exploration; Retina; Malignant hemopathy; Hemorrhage; Fundus of the eye; Vascular disease; Macula; Eye disease; Surveillance; Risk factor; Complication; Predictive factor; Cerebrovascular disease
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.1997.1833000.x

Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4‐year study has been carried out in 82 newly‐diagnosed acute leukaemia patients, aged 12–77 years, who were studied prospectively for the presence of intra‐retinal haemorrhages (IRH), white‐centred haemorrhages (WCH), cotton‐wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra‐cranial haemorrhage (ICH) within the first 30 d following diagnosis. There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5.0, CI 95% [2.03–12.33], P=0.003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3‐AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.