Wounds Resulting from Nonmalignant Hematologic Disease: A Case Series and Literature Review

The umbrella term “Hematologic Disorders” encompasses a wide array of disease processes that affect millions of patients every year. In discussing this subject, it is helpful to first divide between malignant and nonmalignant disease.

Our discussion will be directed towards the nonmalignant pathologies and focus primarily on a small set of acquired and hereditary coagulopathies (immune thrombocytopenic purpura, antiphospholipid syndrome, protein C/S deficiency, warfarin-induced tissue necrosis, thrombotic thrombocytopenic purpura, sickle cell disease, and heparin-induced thrombocytopenia) that produce characteristic wounds or dermatologic findings. An awareness of a patient’s medical history pursuant to anticipating a pattern of pathology that may occur throughout the course of care is an important step in the prevention and treatment of these injuries.

A proactive and systemic approach is imperative to providing care to patients who are predisposed to injury. Population data suggests that the prevalence of hematologic disease is increasing. This increase in patient population is likely due to more effective and increasingly available treatment options. While contemporary treatment provides for a more favorable long-term prognosis and increased life expectancy, there will continue to be a growing population of patients susceptible to the acute and chronic effects of bleeding disorders. It is therefore critical to enhance the precision of our surveillance of this population by reinforcing our familiarity with the presentation of common sequelae.

Here we provide several examples of patients with either a known history or acute diagnosis of a disorder of coagulation, a description of the wound, and the treatment course. We close with a brief discussion describing the presentation of pathology in the cases described, including a summary of the progression of clinical signs, mitigating or exacerbating factors, and suggestions on how best to improve wound care where appropriate. These suggestions will address both local and systemic manifestations.