INTRACRANIAL HEMATOMAS FOLLOWING BONE-MARROW TRANSPLANTATION

Intracranial haemorrhage (ICH) is a known grave complication of leukae mia and has been described post mortem following bone marrow transplan tation (BMT). Ante mortem following BMT, the incidence and significanc e of ICH is not well defined. The records of 471 bone marrow transplan tation recipients over 11 years at the Hadassah University Hospital Bo ne Marrow Transplantation Department were reviewed. The relevant data of all patients with ICH were analysed. A resolute diagnostic and trea tment protocol for subdural haematomas had been employed. The indicati on for transplantation in 273 of the patients was leukaemia. Thirteen of these patients developed subdural haematomas within 42 days of the transplant, and nine of these haematomas were bilateral. None of the 1 98 patients with other malignancies or nonmalignant indications for BM T (predominantly aplastic anaemia and beta thalassaemia major) had sub dural haematomas. One thalassaemia patient and three leukaemia patient s had intracerebral haematomas. There was no mortality or major morbid ity from the subdural haematomas, which were all successfully resolved . In contrast, all of the patients with intracerebral haematomas conse quently died. Subdural haematomas occur in approximately 5% of patient s with leukaemia following BMT, but the clinical outcome is relatively benign. Intracerebral haematomas are a sporadic, lethal complication following BMT. Subdural haematomas are probably due to multiple factor s in leukaemia patients following bane marrow transplantation, promine nt thrombocytopenia invariably being an important element. A determine d diagnostic and treatment protocol can yield results in this potentia lly grave corn plication.