Cryoprecipitate-induced mesenteric venous thrombosis during L-asparaginasetherapy for acute lymphoblastic leukaemia

We present a case of fatal mesenteric vein thrombosis (MVT) associated with L-asparaginase (L-asp) therapy and temporally related to cryoprecipitate i nfusion, in an adult with acute lymphoblastic leukaemia (ALL). Cryoprecipit ate was given on two consecutive days to raise a low fibrinogen level of 0. 7 g/L, in the presence of severe thrombocytopenia and mucocutaneous bleedin g. The thrombotic event presented as sudden abdominal pain a day after the second cryoprecipitate infusion, which raised the fibrinogen to 1.5 g/L. Co ncurrent levels of antithrombin III (AT III), protein C (PC) and protein S (PS) were very low. The patient died after laparotomy and wide resection of gangrenous bowel. We believe this is the first reported case in the Englis h literature of a patient who developed mesenteric venous thrombosis: durin g L-asp therapy, and once more we advise caution in using conventional bloo d products, especially cryoprecipitate, and recommend restricting the use o f cryoprecipitate and fresh frozen plasma (FFP) to the treatment of serious hemorrhagic manifestations, until new effective: and safe therapies are av ailable.