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Related Concept Videos

Disorders of Hemostasis01:24

Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

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Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
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Introduction to Hemostasis01:05

Introduction to Hemostasis

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Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

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Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
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Immunotherapy-associated hemostatic abnormalities: bleeding and thrombotic complications.

Yingying Li1,2,3, Huiwen Jiang1,2,3, Lili Luo4,5,6

  • 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Dadao, Wuhan, 430022, Hubei, China.

Annals of Hematology
|July 1, 2025
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Summary

Immunotherapy can cause severe bleeding and clotting disorders. This review details these hemostatic abnormalities, their mechanisms, and management strategies for better clinical outcomes.

Keywords:
Bispecific antibodiesBleedingChimeric antigen receptor-T-cell therapyImmune checkpoint inhibitorsThrombosis

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Area of Science:

  • Oncology
  • Hematology
  • Immunology

Background:

  • Immunotherapy, including immune checkpoint inhibitors, antibody therapy, and CAR-T-cell therapy, effectively targets cancer by harnessing the immune system.
  • However, immunotherapy is associated with severe, life-threatening hemostatic abnormalities, impacting patient safety.
  • These include immune thrombocytopenia, Evans syndrome, thrombotic thrombocytopenic purpura, acquired hemophilia A, thrombosis, DIC, and CAR-T-associated coagulopathy.

Purpose of the Study:

  • To provide a comprehensive overview of immunotherapy-associated hemostatic abnormalities.
  • To enhance clinicians' understanding of their epidemiology, clinical manifestations, pathophysiology, and management.
  • To guide therapeutic decision-making in the context of immunotherapy safety concerns.

Main Methods:

  • Literature review and synthesis of existing research on immunotherapy and hemostatic disorders.
  • Analysis of epidemiological data, clinical presentations, and proposed pathophysiological mechanisms.
  • Evaluation of current and emerging treatment strategies.

Main Results:

  • Immunotherapy-induced hemostatic abnormalities arise from excessive immune activation, autoantibody production, and inflammatory-coagulation crosstalk.
  • Pathophysiological mechanisms are not fully understood, and standardized management is lacking.
  • These complications pose significant clinical challenges, necessitating timely diagnosis and intervention.

Conclusions:

  • Immunotherapy-associated hemostatic abnormalities are a critical safety concern requiring increased clinical awareness.
  • Further research into underlying mechanisms is essential for developing standardized diagnostic and management protocols.
  • Effective management strategies are crucial for optimizing patient outcomes in cancer immunotherapy.