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Bleeding Propensity in Waldenström Macroglobulinemia: Potential Causes and Evaluation.
Simone A Brysland1, M Gohar Maqbool2, Dipti Talaulikar2,3
1Australian Cancer Research Foundation, Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia.
Thrombosis and Haemostasis
|July 11, 2022
Summary
Waldenström macroglobulinemia (WM) causes bleeding through complex mechanisms, including hyperviscosity and coagulation issues. Understanding these factors is crucial for managing bleeding risks in WM patients undergoing treatment.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Waldenström macroglobulinemia (WM) is a rare, incurable B-cell lymphoma.
- Symptomatic WM often presents with anemia, bleeding, and neurological issues due to infiltration and hyperviscosity.
- The bleeding phenotype in WM is multifactorial, involving acquired von Willebrand syndrome, cryoglobulinemia, and amyloidosis.
Approach:
- This review synthesizes current evidence on the pathophysiology of bleeding in WM.
- It examines factors impacting platelet function and coagulation pathways.
- The review also discusses diagnostic tools for evaluating and managing bleeding in WM patients.
Key Points:
- Bleeding in WM arises from complex, intersecting mechanisms, not solely platelet defects.
- Hyperviscosity, acquired von Willebrand factor syndrome, cryoglobulinemia, and amyloidosis contribute significantly.
- Therapies for WM, like chemo-immunotherapy and BTK inhibitors, increase bleeding risks.
- Comorbidities and anticoagulant/antiplatelet use in older WM patients exacerbate bleeding concerns.
Conclusions:
- A comprehensive understanding of WM bleeding mechanisms is essential for risk stratification.
- Improved diagnostic tools are needed for better patient management and treatment decisions.
- Addressing the bleeding phenotype is critical for optimizing care in Waldenström macroglobulinemia.
