[Interventional management of gastrointestinal and uterine bleeding in a patient with acute myeloid leukemia on induction therapy: case report].

Abstract

Bleeding involves morbidity and mortality in patients with acute myeloid leukemia (AML) receiving induction therapy. The concomitant presentation of gastrointestinal and uterine bleeding is rare as described in the literature, and its approach is not standardized. The following is an illustration of a case in which interventionism was effective and safe. A 44-year-old woman recently diagnosed with acute myeloid leukemia was started on induction therapy with cytarabine and idarubicin and presented 10 days after its initiation with rectorrhagia, melena and abnormal uterine bleeding. Due to clinical deterioration, she was transferred to the intensive care unit and required massive transfusion therapy. She needed angiotomography of the abdomen, with a probable area of active bleeding in the thin loop of the proximal jejunum, as well as contrasted resonance of the abdomen and pelvis, with multiple myomatosis and endometrial thickening. Abdominal arteriography was performed, requiring supra-selective embolization of the distal branch of the superior mesenteric artery supplying the jejunum. Subsequently, selective aorto-iliac arteriography was performed, proceeding to complete occlusion with coils of uterine arteries bilaterally. Post-procedure evolution, without new signs of bleeding. Imaging control ruled out complications. She completed the induction scheme and was discharged on the 45th day of hospitalization to continue the chemotherapy maintenance scheme on an outpatient basis. Early arteriography and embolization are viable, safe and effective procedures both for the management of gastrointestinal and uterine bleeding in patients with AML receiving induction therapy.