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.¹ Since then approximately 50 additional cases have been reported, of which the majority have had sizeable benign hemangiomas, thrombocytopenia, and a severe bleeding diathesis.^2,3 Although 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.^4-9 In 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