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Hemorrhagic complications in patients with advanced hematological malignancies followed at home: an Italian experience.
- Source :
-
Leukemia & lymphoma [Leuk Lymphoma] 2009 Mar; Vol. 50 (3), pp. 387-91. - Publication Year :
- 2009
-
Abstract
- Patients with advanced hematological malignancies may experience many troublesome hemorrhagic complications requiring hospitalisation during a palliative home care (HC) program. We report on the feasibility of the management of bleeding at home in patients with haematological malignancies admitted in a domiciliary HC program. The occurrence of a major hemorrhage episode (>1 WHO grade) was registered among 469 patients with hematological malignancies in the terminal phase of their disease followed at home. Number, sites, domiciliary treatment (local hemostatic measures, platelet units, hemostatic drugs, packed red blood cells) and outcome of hemorrhagic complications were evaluated. Out of 469 patients, 123 (26%) experienced a bleeding complication; the overall number of hemorrhagic episodes was 232 (49%) with a median number of 2 episodes per patient. Patients with a platelet count lower than 20 x 10(9)/L (P < 0.00005) or with a diagnosis of acute leukemia or in blast crisis of myeloprolypherative disorders (P < 0.00005) showed a significant higher incidence of hemorrhages than other patients. Resolution of bleeding at home was obtained in 206 (88%) of the 232 episodes; platelet units were transfused at home in 188 (81%) cases. Bleeding was the cause of hospitalisation in four cases. Death occurred in 447 of 469 patients: in 26 of them (6%), it was caused by bleeding complications (11 brain hemorrhage, 2 hematemesis, 3 hemoptysis and 10 melena). In this group of patients, bleeding was a relevant clinical problem However, by implementing a domiciliary palliative care program, home management of hemorrhages proved to be a safe and effective choice.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Child
Child, Preschool
Disease Management
Female
Hematologic Neoplasms mortality
Hemorrhage mortality
Hemorrhage therapy
Humans
Incidence
Italy
Male
Middle Aged
Palliative Care
Survival Rate
Treatment Outcome
Young Adult
Hematologic Neoplasms complications
Hemorrhage etiology
Home Care Services
Subjects
Details
- Language :
- English
- ISSN :
- 1029-2403
- Volume :
- 50
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Leukemia & lymphoma
- Publication Type :
- Academic Journal
- Accession number :
- 19347728
- Full Text :
- https://doi.org/10.1080/10428190802714024