Thrombotic complications in patients with hematological malignancies based on autopsy data

The aim was to study the features of thrombosis and thromboembolism in the deceased patients with hematological malignancies, their relationship with underlying diseases and role in the development of lethal outcomes. Materials and methods. The autopsy records of 60 patients with hematological malignancies and thrombotic complications died during the period of 25 years (1987-2011) in Lviv were reviewed. The following data were obtained: age, sex, postmortem pathological patterns, locations of thrombi, and associated underlying diseases. Frequency tables were obtained by the Fisher's exact test. Results. The median age was 58 years old. There were 36 males and 24 females. Lymphoid neoplasms were diagnosed in 43 cases, myeloid neoplasms in 16 cases and mixed-phenotype acute leukemia in the one case. Venous thromboembolism predominated over arterial one (60% vs 17%, P < 0.001), and thrombi in heart chambers were detected in 8% of cases. Thrombotic complications were the direct cause of death in 45% of patients. Thrombosis was diagnosed in vivo only in 35% of patients. In deceased with lymphoid neoplasms, in comparison with cases of myeloid neoplasms, pulmonary embolism was more common (65% vs 25%, P < 0.01), as well as local thrombi in small vessels (51% vs 19%, P < 0.05), which were associated with necrotic changes in tumors in 37% of cases. Surgical interventions were performed during a two-week period before lethal outcomes in 33% of patients with lymphoid neoplasms. Conclusions. Thrombosis and thromboembolism in patients with hematologic neoplasms often causes a lethal outcome, in particular, due to frequent undiagnosed cases. Lymphoid neoplasms are the high risk factor for venous thromboembolism and local thrombosis of small vessels. Surgical operations are the weighty factor of thrombotic risk in such patients.