慢性粒细胞白血病合并脑出血一例

Chronic Myeloid Leukemia Complicated with Cerebral Hemorrhage: A Case Report

摘要: 目的：探讨慢性粒细胞白血病(chronic myeloid leukemia, CML)合并脑出血的临床特点及诊疗策略。方法：回顾性分析1例以头痛、肢体乏力为首发症状，外周血白细胞及血小板极度升高，经骨髓检查及基因检测确诊为CML合并脑出血的老年女性患者的诊治过程。结果：患者凝血功能正常，BCR-ABL p210阳性，确诊CML慢性期。急诊行血肿钻孔引流术，术后予羟基脲、干扰素及伊马替尼治疗，白细胞、血小板水平显著下降，颅内出血吸收良好，未遗留神经功能障碍。结论：CML合并脑出血虽属少见，但病情凶险，临床应予以高度重视。急诊手术联合TKI靶向治疗在本病例中具有良好的安全性和疗效。需注意的是，即使凝血功能正常，对于血小板极度增高的CML患者，仍应高度警惕脑出血的可能。

Abstract: Objective: To investigate the clinical characteristics and therapeutic strategies of chronic myeloid leukemia (CML) complicated with cerebral hemorrhage. Methods: The diagnosis and treatment process of an elderly female patient with CML complicated with cerebral hemorrhage was retrospectively analyzed. The patient presented with headache and limb weakness as the initial symptoms, with extremely elevated peripheral white blood cell and platelet counts, and was definitively diagnosed with CML by bone marrow examination and genetic testing. Results: The patient had normal coagulation function and tested positive for BCR-ABL p210, confirming the diagnosis of chronic-phase CML. Emergency burr-hole drainage of the hematoma was performed, followed by treatment with hydroxyurea, interferon, and imatinib. The white blood cell and platelet levels decreased significantly, intracranial hemorrhage was well absorbed, and no neurological dysfunction was observed. Conclusion: CML complicated with cerebral hemorrhage is rare but critical, and high clinical attention should be paid to this condition. In this case, emergency surgery combined with TKI-targeted therapy demonstrated favorable safety and efficacy. It should be noted that even in patients with normal coagulation function, those with markedly elevated platelet counts should remain vigilant for the possibility of cerebral hemorrhage.