PO0003 - Treatment challenge of an intracranial hemorrhage: a life-threatening complication of aplastic anemia

Background: Aplastic anemia (AA) is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. Anemia, bleeding, and infection are usually presenting symptoms. Intracranial hemorrhage (IH) is a life-threatening complication of AA.

Aims: We aim to examine laboratory and radiological findings in two patients with intracranial hemorrhage associated with AA and their therapeutic approach.

Methods: A 12-year-old boy with a diagnosis of severe acquired AA was admitted to our hospital. After multiple bleeding episodes and febrile neutropenia he developed a bulky, spontaneous hematoma without surgical indication. The course of treatment was medical: eltrombopag, immunoglobulin plus methylprednisolone, platelet transfusion and FVII, FXIII and fibrinogen administration as needed.
A 70-year-old woman with severe acquired AA and prior hypertension, atrial fibrillation and multiple bleeding events was admitted to our hospital after reporting a strong progressive headache, nausea and generalized lack of strength. CT scan brain imaging reveal an intracranial bleeding (several cerebral micro-bleeding sites and a hemorrhage on the right cerebellar hemisphere). The course of treatment was medical: immunoglobulin plus
dexamethasone, eltrombopag, fibrinogen correction and platelet transfusion.

Results: Three months later the boy’s hematoma reabsorbed and he was refered for allogenic transplantation with hematopoietic progenitor cells.
On the other hand, despite the severity of the intracranial hemorrhage, an optimized medical treatment allowed the woman to have medical release to ambulatory follow-up two weeks later.

Conclusion(s): IH is a serious complication of pancytopenia in AA, potentially lethal and should be treated as soon as the diagnosis is made. A detailed patient history and physical examination as well as laboratory and radiological monitoring are crucial to the management of intracranial bleeding in this context. In some cases, conservative treatment can be effective by correcting the thrombocytopenia and clotting factor levels.