Intracranial Hemorrhage in Patients with Hematologic
Disorders: Prevalence and Predictive Factors
Weerapat Owattanapanich MD*,
Chirayu U Auewarakul MD, PhD*
Affiliation :
* Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Background : Intracranial hemorrhage (ICH) is an uncommon complication in patients with hematologic disorders although
high fatality rates have been shown in these patients. At present, no epidemiological data regarding ICH in patients with
hematologic disorders has been collected and/or reported in Thailand.
Objective : The purpose of this study was to determine the incidence of ICH in hospitalized patients with hematologic
disorders and to identify predictive factors associated with ICH in these patients.
Material and Method: The medical records of all patients with hematologic disorders admitted to Siriraj Hospital (Bangkok,
Thailand) between January 2002 and September 2011 were reviewed. Patients with ICH were identified and factors associated
with ICH were investigated using a retrospective case-control design.
Results : Of 9,627 patients identified with hematologic disorders, ICH was diagnosed in 106 (1.1%). The ICH rate was
higher in acute myeloid leukemia (AML) patients than in patients with other hematologic malignancies (4.29% vs. 0.78%;
p<0.001) and higher in aplastic anemia (AA) patients than in patients with other benign hematologic disorders (4.00% vs.
0.97%; p<0.001). Cortical hemorrhage was the main presentation in all hematologic disorders, with a single lesion in the
parietal area as the most common site. The overall mortality rate was 85% with most patients succumbing within two days
of onset. The independent predictors of ICH were hyperleukocytosis and a low platelet count in AML patients, and ecchymosis,
upper gastrointestinal hemorrhage, hematuria, and a low platelet count in AA patients.
Conclusion : AML and AA patients had the highest risk of ICH compared with other hematologic disorders and several
predictive factors for ICH were identified.
Keywords : Acute myeloid leukemia, Aplastic anemia, Hematologic disorder, Hematologic malignancy, Intracranial
hemorrhage
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