Dasatinib causing Intracerebral Bleeding in a Patient with Chronic Myeloid Leukaemia

Dasatinib is a potent inhibitor of BCR-ABL (break point cluster-Abelson) kinase, Src family of kinases, C-kit, and Platelet Derived Growth Factor Receptor beta (PDGFR-beta), and used in the treatment of Chronic Myeloid Leukaemia (CML), Ph-positive acute lymphoblastic leukaemia, and Acute Myeloid Leukaemia (AML). The most common side effects of dasatinib are myelosuppression, gastrointestinal disturbance, fluid retention, cutaneous eruption, and bleeding diathesis. This report is about a recently diagnosed, 45-year-old female with CML, BCR-ABL positive. After six-month therapy with imatinib, the patient developed resistance to imatinib. The treatment was changed to dasatinib 70 mg, once a day. Three months after starting the therapy, the patient showed a cytological response. While receiving dasatinib, she complained of headaches, nausea, and vomiting. Her complete blood count was within the normal limit. Coagulogram was within the normal limit. Non Contrast Computerised Tomography (NCCT) of the head showed intracerebral bleed in the right frontal area of the brain. The patient was then treated with mannitol and put on artificial ventilation. She succumbed on day fourth of the Intensive Care Unit (ICU). Dasatinib has been associated with impaired platelet aggregation, and can show fatal bleeding manifestations.