Bleeding diathesis coincident with chronic myelomonocytic leukaemia

Area of Science:

• Hematology
• Oncology
• Coagulation Disorders

Background:

• Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell disorder.
• Acquired hyperfibrinolytic bleeding disorders are rare and complex.
• Coagulation factor deficiencies can lead to significant bleeding risks.

Observation:

• A 78-year-old male patient exhibited both CMML and a hyperfibrinolytic bleeding disorder.
• The bleeding disorder involved prolonged coagulation times and deficiencies in factors V, X, XI, antithrombin III, and proteins C and S.
• Elevated tissue plasminogen activator (t-PA) and reduced plasminogen activator inhibitor (PAI-1) were noted.

Findings:

• A potential causal link between CMML and the hyperfibrinolytic state was investigated.
• Peripheral blood monocytes were hypothesized to mediate hyperfibrinolysis through abnormal t-PA production.
• This association between CMML and acquired hyperfibrinolysis is novel.

Implications:

• Understanding this link could reveal new pathomechanisms in CMML.
• Targeting monocyte-derived t-PA may offer therapeutic strategies for bleeding in CMML patients.
• This case highlights the importance of investigating complex bleeding disorders in hematological malignancies.