Severe Hemorrhage from Gastric Vascular Ectasia Developed in a Patient with AML

Abstract

Gastrointestinal hemorrhage is a troublesome complication in patients with hematologic diseases. Gastrointestinal bleeding in patients with acute leukemia may be the result of chemotherapy, coagulopathy, or infection. Herein, we report a case of acute myelogenous leukemia (AML) that developed severe hemorrhage from gastric vascular ectasia (GVE) lesions, which were fully resolved after achieving a complete remission (CR). A possible relationship between AML and the development of GVE was suspected. A 70-year-old man was admitted to our hospital in September 2005, because a diagnosis of acute leukemia was suspected. A few days before admission, he was presented to another hospital because of worsening fatigue and allegedly having tarry stools. He had anemia (hemoglobin concentration was 7.6 g/dL) and severe thrombocytopenia (platelet count was 2000/ L). He was transferred to our hospital after 2 units of packed red blood cells and 15 units of concentrated platelet plasma were transfused. He had a history of acute myocardial infarction at the age of 63. Physical examination disclosed no abnormal findings except for anemia and petechiae in the trunk. A peripheral blood examination revealed that the leukocyte count was 7300/ L with 48% blasts, the hemoglobin concentration was 9.7 g/dL, and the platelet count was 66,000/ L. Liver function test results were normal. Occult blood of the feces was negative. A bone marrow aspiration revealed the proliferation of blasts without maturation in 50.3% of all nucleated cells and in 93.2% of non-erythroid cells. Only a few blasts had Auer rods or azure granules. More than half of the blasts were positive for peroxidase staining. Thus, a diagnosis of AML without maturation (M1 phenotype according to the FrenchAmerican-British classification) was made. The blasts were Severe Hemorrhage from Gastric Vascular Ectasia Developed in a Patient with AML