L-asparaginase induced intracranial haemorrhage in acute lymphoblastic leukemia

A 20-year-old national serviceman with acute lymphoblastic leukaemia, developed a large left parieto-occipital haemorrhage 7 days after completion of induction chemotherapy. Severe hypofibrinogenemia had been noted while he was receiving L-asparaginase. The haemorrhage could not be attributed to thrombocytopenia, disseminated intravascular coagulopathy, arterio-venous malformation, berry aneurysm or leukaemic infiltration because each of these causes was carefully investigated into and excluded. We conclude that the intracranial haemorrhage was likely L-asparaginase induced, an uncommon but recognised complication associated with L-asparaginase therapy.