Leukemia is caused by an overproduction of white blood cells in a person’s bone marrow. Since it is a blood cancer, leukemia may increase the risk of bleeding and clotting. Certain types of leukemia have a higher risk for blood clots, and the treatments for any type of leukemia can also increase these risks.

Abnormal bleeding and clotting can be dangerous, so it’s important for people living with leukemia to recognize the signs and symptoms and be aware of possible treatments.

Recognizing Abnormal Bleeding and Blood Clots

Milder symptoms of abnormal bleeding may be difficult to notice. Some common symptoms of abnormal bleeding can include:

• Multiple bruises
• Nosebleeds
• Joint swelling and tenderness

In addition, people experiencing abnormal bleeding may feel more tired than normal when they exert themselves, or simply more tired in general. Bleeding due to leukemia can also impact the menstrual cycle and cause longer or heavier periods.

Abnormal blood clots can be a medical emergency. They may cause swelling, tenderness, pain, or discolored skin. These symptoms are usually in the lower leg. If you experience any of these blood clot symptoms, reach out to your medical provider immediately.

Blood clots can also cause:

• Shortness of breath
• Rapid heart rate
• Fatigue
• Fever

These symptoms, too, are serious. Bottom line: Blood clots require emergency medical treatment.

Types of Blood Clots

When a blood clot forms in a large vein of someone’s body, they have a deep vein thrombosis (DVT). These DVTs typically form in the areas of the body where blood flow is most likely to slow down. Often DVTs are located in the veins of the calf and lower leg, where blood flow is the slowest.

In some cases, blood clots break up and migrate throughout the body. These can land in the liver, heart, or lungs. If a blood clot is in the lungs, it is called a pulmonary embolism. A pulmonary embolism carries a higher risk than other clots because it can impact breathing. Pulmonary embolisms are medical emergencies and should be evaluated and treated by medical professionals.

Clotting and bleeding may happen at any time, so it is important to be vigilant of the symptoms.

What Causes Abnormal Bleeding and Blood Clots With Leukemia?

Leukemia can disrupt the body’s natural clotting and anti-clotting factors. That disruption increases their risk of bleeding and developing blood clots.

Every type of leukemia is different and each carry different risks:

• Acute promyelocytic leukemia (APML) — Carries a high risk of bleeding, particularly in the early stage of treatment
• Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) — Carry a high risk for developing blood clots, while ALL in particular increases blood thickness (viscosity)

Talk to your doctor about your specific type of leukemia and its risk level for abnormal bleeding or clotting.

Catheters for Chemotherapy

Catheters are thin, bendable plastic tubes. When someone with leukemia is undergoing chemotherapy, one end of a catheter is inserted by needle into one of their veins. When the needle is pulled out, one end of the catheter remains in their vein while the other is in the open. Medicine can be fed into the exposed end when a drip bag with chemotherapy drugs is connected. This is called an infusion. Medicine can also be injected directly into the catheter.

Blood clots can form around catheters, including the central line. (“Central line” is the name for the catheter that delivers someone’s chemotherapy drugs.) Central lines often remain in place over the course of a person’s treatment. In those cases, over time, the area around the catheter becomes inflamed. This inflammation can enable a protein called “tissue factor” to mingle with blood cells.

When tissue factor comes in contact with blood cells, coagulation follows. (Coagulation is when blood thickens and hardens or solidifies altogether.) If a clot breaks off, it creates a DVT — and DVTs cause complex problems. Since DVTs are frequently identified around catheters, treatments are specifically designed to reduce both their development and size.

Leukemia Treatments That Raise the Risk of Clots

Certain drugs used in chemotherapy are known to increase the risk of blood clots. These include:

• L-asparaginase — Used to treat ALL
• Cisplatin — Used to treat AML
• Fluorouracil (5FU) — Used to treat several different cancers

Some medications used alongside chemotherapy (like steroids and granulocyte colony-stimulating factors agents, or G-CSFs) may also lead to blood clot formation.

Managing Abnormal Bleeding and Blood Clots in Leukemia

Many different approaches are used to treat — and prevent — abnormal bleeding and blood clots in people with leukemia. Part of monitoring for signs of a DVT include getting regular blood tests. (These tests can reveal early signs of bleeding.) If you have ever had increased bleeding or unusual blood clots, make your health care provider aware. There may be testing and treatments available to reduce your chance of developing clots or bleeding.

Managing Abnormal Bleeding

Abnormal bleeding from leukemia is often treated with blood transfusions. Transfusions of blood products — like red blood cells and platelets — may be used to help stop bleeding and resolve anemia. (Anemia is a condition caused by low levels of red blood cells.)

Preventing Blood Clots

Stagnant blood flow (blood stasis) is known to increase someone’s risk for developing blood clots. To promote healthy blood flow, people with leukemia are often encouraged to stay mobile and exercise regularly.

Try these tips to lower your risk for blood clots:

• Exercise your legs and arms specifically.
• Move your legs if you are in bed for long periods.
• Take breaks to stretch and walk (or pace) if you sit for long stretches.
• Wear compression stockings.
• Consider intermittent compression devices, which apply a gentle squeeze to stimulate blood flow.

Treating Blood Clots

The most commonly used medicines for blood clots are anticoagulants (blood thinners). Common anticoagulants include:

• Apixaban (Eliquis)
• Rivaroxaban (Xarelto)
• Heparin
• Warfarin (Coumadin or Jantovin)

If you have a high risk of blood clots, or if you have formed blood clots in the past, your doctor may prescribe a long-term anticoagulant. These medicines can help reduce your risk of clotting. And anticoagulants can ensure that any clots that have already formed don’t grow larger.

Some people are unable to take anticoagulant medications. There are other treatment options available for them that also manage clots. In some cases, a medical device called an inferior vena cava filter (IVC filter) may be used. The IVC filter is implanted in the heart to catch any blood clots that appear. Catching a clot in the heart also prevents it from reaching the lungs.

Talk With Others Who Understand

On My LeukemiaTeam, the social network for people living with leukemia and their loved ones, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you experienced bleeding or clotting issues with leukemia? Share your experience in the comments below, or start a conversation by posting on your Activities page.