Pathophysiology

• Rare complication of tumours close to or eroding through a major vessel.
• Greatly feared by families and patients.
• In reality very rare.

Signs and symptoms

• May complicate lymphopoietic conditions such as leukaemia in which platelet numbers and function are both reduced.
• Often preceded by oozing, epistaxis or haemoptysis.
• Correlation of platelet numbers with risk of haemorrhage is poor, and platelet numbers alone should not be an indication for transfusion.

Management

• Be aware of the possibility of haemorrhage and anticipate it.
• Platelet transfusions, tranexamic acid, etamsylate to optimise clotting.
• Soften impact by discussion with family, and provision of green towels against which blood is less obvious should haemorrhage occur.
• Arrange for parenteral quick acting anxiolytic such as Midazolam, and analgesics such as diamorphine to be by the patient’s bedside in case haemorrhage should occur.