Clotting-Fibrinolysis in a Cavernous Hemangioma

Abstract

THE ASSOCIATION of a bleeding tendency with giant cavernous hemangiomas was first noted in 1940 by Kasabach and Merritt.1Since then approximately 50 additional cases have been reported, of which the majority have had sizeable benign hemangiomas, thrombocytopenia, and a severe bleeding diathesis.2,3Although many etiologies have been proposed, recently it has been appreciated that more than just platelets are depressed in a typical case. Five or more patients with extensive evaluations have now been shown to have not only thrombocytopenia but also low fibrinogen levels, depressed clotting factors V and VIII, and activation of fibrinolytic systems.4-9In view of this new evidence the concept of clotting-lysis, a continuous clotting process in the hemangioma with subsequent rapid lysis of the clot, has been introduced. Reversibility of two of the cases by anticoagulation has supported the theory.3,7 To further characterize the clotting-lysis mechanism, we employed tracer doses