[Diagnosis and treatment of oncologic emergency due to bleeding]

Processes of malignancy and hemostasis can in principal interact in both directions: that is, malignant growths could affect hemostasis and components involved in hemostasis could affect malignant growths. Interactions in the first direction are exemplified by the association of various types of thromboembolism with malignancy, including DIC in patients with disseminated malignant diseases. It is also noted that thrombocytopenia, whether due to crowding out of megakaryocytes by malignant invasion of the bone marrow or exposure to radiation or chemotherapeutic drugs, is a common cause of hemorrhage in malignancy. Depression of coagulation factors may result from obstructive jaundice or liver dysfunction. Since hemorrhage is a common symptom even in cases of malignancy without marked disturbance in hemostasis, it is of importance to rule out bleeding tendency including DIC by the results of "screening tests" for hemostatic abnormality. Massive hemorrhage may occasionally occur in patients with malignancy regardless of their hemostatic state. Treatment of these life-threatening massive hemorrhages in patients with or without bleeding tendency is described.