Haematoma

[Mwalimu]

I have ET and at my last blood test (2 months ago) my platelets were well-controlled at 459. In the past I had an occlusion of a vein in my left eye (2016) and have lost sight in the central panel, and last year I had blood clots in both lungs as a result of which my daily 75 mg aspirin was augmented by a daily 20 mg of rivaroxaban. 6 days ago a large bruise appeared on my upper left arm , almost circular with a lump in its centre which hurts when pressed. The bruise is gradually turning yellow and not getting any bigger although the lump seems unchanged. I feel I would have known if I had hit myself because of its size and position.

I happened to be at the doctor's so showed her and she said there was no problem that, it was a haematoma and to leave it.. However, a relative with a medical background has just told me further checks should have been made. My question is: does anyone with experience of these things think I should follow it up with my haematologist NOW as opposed to waiting until my scheduled appointment on Sept 5. Hoping for guidance! Sallie

[hunter5582]

Combining an anticoagulant with an antiplatelet medication comes with an intrinsic increased risk of hemorrhage. Both medications come with a risk of hemorrhage; together more so. Monitor/Modify Tx aspirin + rivaroxaban monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, incl. life-threatening (additive effects) epocrates.com/online/intera... .

Given your history of significant thrombotic incidents, the risk-benefit ratio of your treatment plan seems well justified; however, there are intrinsic risks. Sometimes the treatment plan does need to be altered to deal with the response to the medications. The occurrence of a significant unexplained hematoma is something your MPN care team should know about sooner rather than later. While this bruise is likely not a major risk, there are other types of hemorrhage that could be more significant.

Suggest letting your MPN care team know about the incident immediately. They know your history and can determine whether this can wait until the next appointment or needs to be dealt with as an emergent issue. It definitely does need to be followed up on as soon as possible.

Please do let us know how you get on and what you learn.

[Mwalimu in reply to hunter5582]

Thank you, Hunter. Will contact them asap. Sallie