Bleomycin Sclerotherapy Is Laboratory Monitoring Necessary?

Abstract

Objectives: Bleomycin is a chemotherapeutic agent also used as a sclerosant for the management of vascular malformations. Although effective and with a low complication profile, the safety and monitoring necessary for this indication is still controversial. This study examines routine periprocedural laboratory results on a cohort of patients undergoing bleomycin sclerotherapy. Methods: Retrospective chart review of prospectively collected data was performed on patients who underwent bleomycin sclerotherapy for vascular malformations from 2011 to 2018. Complete blood count and liver function were assessed before and after sclerotherapy. Results: Forty-six patients were identified who underwent a total of 71 sclerotherapy sessions with bleomycin. A median dose of 5 U/m2 of bleomycin was used per procedure (8 U total). No difference between preprocedure and postprocedure values was detected for white blood cell count (7.7–7.9; P = .63) or absolute neutrophil count (4009–4414; P = .20). A nominal difference was found in hemoglobin (12.7–13.0; P = .001), hematocrit (37.0–38.6; P = .001), and platelet counts (278–302; P = .001). No patient had absolute neutrophil count levels below 500 cells/μL. On liver function tests, no change was detected for direct bilirubin (0.19–0.17; P = .4). A small decrease in total bilirubin (0.49–0.41; P = .004), aspartate aminotransferase (32.1–26.9; P < .001), and alanine aminotransferase (31.2–24.3; P < .001) was shown. Conclusion: This study suggests that laboratory assessment of immune and liver function, as commonly performed in chemotherapy protocols, is not required following intralesional bleomycin sclerotherapy. Clinically relevant abnormalities are unlikely to be detected as demonstrated in this cohort of patients with vascular malformations.