Successful treatment of severe gastrointestinal bleeding after chemotherapy in acute myeloblastic leukemia with recombinant activated factor VII : report on one case and review of other uses in acute leukemias.

Hemorrhage is a frequent complication in patients with acute leukemias as a result of chemotherapy-induced myelosuppression. Gastrointestinal bleeding in thrombocytopenic patients carries a high mortality. Patients are generally managed with red blood cell, platelet suspensions, and fresh frozen plasma; and sometimes with pharmacologic and endoscopic interventions. If these therapeutic measures fail, patients might be treated with hemostatic drugs, one example of which is recombinant activated factor VII (rFVIIa). This drug is recommended for all kinds of bleeding in hemophiliacs with inhibitors; it is also being used for the treatment of bleeding in thrombocytopenia and platelet function disorders. We present our 44-year-old female patient who had gastrointestinal system bleeding after remission induction therapy for acute myeloid leukemia. Thrombocytopenia was refractory to apheresis platelets; and gastrointestinal bleeding could be controlled only after the administration of a single dose (35 microg/kg, total dose 2.4 mg) of rFVIIa. Our experience indicates that rFVIIa might be a novel treatment alternative in massive bleeding in leukemic patients with thrombocytopenia or platelet function disorders.