Bilateral Compartment Syndrome Affecting the Upper Limbs in a Patient With Chronic Myeloid Leukemia

A 70-year-old male patient who had recently been recently diagnosed with chromic myeloid leukemia (CML) presented to the emergency department with bilateral upper limb pain and swelling. Examination of his upper limbs revealed features suggestive of compartment syndrome. Blood investigations demonstrated anaemia, rhabdomyolysis and renal function impairment. Because of the rapid fall in hemoglobin levels, he required clotting factors and blood product resuscitation. Compartment pressure measurements were elevated, confirming the diagnosis of bilateral acute compartment syndrome secondary to bleeding. Initial investigations demonstrated low factor XIII levels. Once stabilized, he underwent bilateral fasciotomies but required intensive care management post-surgery, including ongoing blood product resuscitation and renal replacement therapy. Levels of factor XIII continued to fall. Although there have been reported cases of acute leukaemia involving factor XIII deficiency, reports of chronic leukaemia involving factor XIII deficiency are rare. This case provides key learning of a known complication of acute leukaemia and highlights a rare surgical complication of factor XIII deficiency.