Clinical and pathologic studies of gastrointestinal hemorrhage in acute leukemia

One hundred and sixty cases of acute leukemia observed at our Department between 1953 and 1977 were reviewed as to the presence and nature of the accompanying gastrointestinal hemorrhage. A massive gastrointestinal hemorrhage requiring blood transfusions occurred in 29 cases (18%). The most common lesion was hemorrhagic necrosis of the small intestines. There were three forms of hemorrhage: Type I: thrombocytopenia, hemorrhagic diathesis, diffuse hemorrhage of mucosa and submucosa, but no erosion nor ulceration. Type II: no specific pathologic findings. Diffuse hemorrhage, superficial erosions, bacterial and fungal invasions were observed. Type III: single and/or multiple ulcerations, necrosis and perforation of the small intestines and colon. Thrombocytosis was almost always present at the prebleeding phase in these cases. Intravascular microthrombi at the basis of ulceration were seen. Usually, more than one process were seen in each case. An appropriate approach to the severe gastrointestinal hemorrhage with a combination of anti-leukemic chemotherapy, anti-coagulant therapy, platelet transfusion, etc. would further add to the number of long-term survivors in acute leukemia.