Bick R L
Semin Thromb Hemost. 1978 Summer;5(1):1-26. doi: 10.1055/s-0028-1087142.
As outlined in this paper, the patient with disseminated malignancy suffers many alterations of hemostasis; in addition, hemorrhage or less commonly thrombosis is the final clinical event in many of these patients. Patients with malignancy present a major clinical challenge in this day of new oncological awareness and more aggressive care. Thus, it is important to realize that these alterations of hemostasis do exist and they must be approached in a logical manner with respect to diagnosis as well as efficacious therapy. By far the most common alteration of hemostasis in malignancy is that of hemorrhage associated with thrombocytopenia either drug-induced or from bone marrow invasion. However, hemorrhage due to disseminated intravascular coagulation is also quite common. In addition, many antineoplastic drugs, as well as radiotherapy, may lead to hemorrhage in these patients. Thrombosis, which is also commonly seen in the patient with malignancy, is usually a manifestation of disseminated intravascular coagulation manifest as an intravascular thrombotic rather than an intravascular proteolytic event. When suspecting this, confirmatory laboratory evidence must be sought and the patient treated apropriately. When approaching the patient with malignancy and either hemorrhage or thrombosis, all of the potential defects in hemostasis must be taken into account, defined from the laboratory standpoint, and treated in as precise a manner as possible.
如本文所述，播散性恶性肿瘤患者存在许多止血功能改变；此外，出血或较少见的血栓形成是这些患者中许多人的最终临床结局。在当今肿瘤学认识不断提高且治疗更为积极的时代，恶性肿瘤患者带来了重大的临床挑战。因此，重要的是要认识到这些止血功能改变确实存在，并且必须从诊断和有效治疗的角度以合理的方式来处理。迄今为止，恶性肿瘤中最常见的止血功能改变是与血小板减少相关的出血，血小板减少可能是药物诱导的，也可能是骨髓浸润所致。然而，弥散性血管内凝血导致的出血也相当常见。此外，许多抗肿瘤药物以及放疗都可能导致这些患者出血。血栓形成在恶性肿瘤患者中也很常见，通常是弥散性血管内凝血的表现，表现为血管内血栓形成而非血管内蛋白水解事件。怀疑有这种情况时，必须寻找确诊的实验室证据并对患者进行适当治疗。在处理患有恶性肿瘤且有出血或血栓形成的患者时，必须考虑到所有潜在的止血缺陷，从实验室角度进行明确，并尽可能精确地进行治疗。
