High-Risk Bleeding in Acute Myeloid Leukemia: Clinical Presentation, Laboratory Markers, and Mortality Trends

BackgroundSevere bleeding is a major complication in acute myeloid leukemia (AML), contributing to early mortality. While thrombocytopenia and coagulopathy are known risk factors, the clinical and laboratory features surrounding haemorrhagic events in real-world AML cohorts require further elucidation.ObjectivesTo assess the frequency, sites, clinical features, laboratory findings, and outcomes of Grade ≥3 bleeding in AML patients.MethodsThis retrospective study reviewed 214 AML patients treated between 2012 and 2021 at a tertiary centre in Qatar. Patients with WHO Grade ≥3 bleeding were analysed for clinical, laboratory, cytogenetic, and outcome data.ResultsThirty-five patients (16.3%) had Grade ≥3 bleeding, most commonly intracranial (86%), presenting with neurological symptoms (80%). Events occurred mainly during or soon after induction chemotherapy (40%). Median haemoglobin and platelet count at bleeding were 7.1 g/dL and 11 × 10⁹/L. Most cases (94%) were managed medically; 6% required neurosurgery. Thirty-day mortality was 41.2%, with overall mortality reaching 76.5%. Intracranial hemorrhage and septic shock accounted for most deaths.ConclusionsGrade ≥3 bleeding, particularly intracranial, is a frequent and deadly event in AML, often arising during induction. Severe cytopenias and coagulopathy are common. Improved risk stratification and supportive care are essential to reduce bleeding-related mortality.