Near‐fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: A case report of bilateral uterine artery embolization

Severe transfusion‐dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life‐threatening uterine hemorrhage in a 38‐year‐old woman in the setting of transfusion‐refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, ϵ‐aminocaproic acid, and intracavitary thrombin‐soaked gauze tamponade. At the point of near‐exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/μL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting. Am. J. Hematol. 77:151–155, 2004. © 2004 Wiley‐Liss Inc. © 2004 Wiley‐Liss, Inc.