Page 397 - Essential Haematology

Chapter 28 Haematological changes in systemic disease / 383

(a) (b) (c)

(d) (e) (f)

Figure 28.1 Metastatic carcinoma in bone marrow aspirates: (a) breast; (b) stomach; (c) colon; bone marrow
trephine biopsies: (d) prostate; (e) stomach; (f) kidney.

tumours, particularly mucin - secreting adenocarci- factor, most frequently factor VIII, or to a parapro-
nomas, are associated with disseminated intravascu- tein interfering with platelet function.
lar coagulation (DIC; see p. 355 ) and generalized Cancer patients have a high incidence (esti-

haemostatic failure. Activation of fi brinolysis occurs mated at 15%) of venous thromboembolism. Th is
in some patients with carcinoma of the prostate. is increased by surgery and some drugs (e.g. thalido-
Occasional patients with malignant disease have mide). It is most common in ovarian, brain,
spontaneous bruising or bleeding caused by an pancreatic and colon cancers. It may be diffi cult
acquired inhibitor of one or other coagulation to manage with oral anticoagulation because of