PEDIATRICS Vol. 79 No. 6 June 1987, pp. 971-980
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Kasabach-Merritt Syndrome: Therapeutic Considerations

Eric C. Larsen MD1, William H. Zinkham MD1, Joseph C. Eggleston MD1, and Basil J. Zitelli MD1

1 From the Department of Pediatrics, The Johns Hopkins Hospital and The Johns Hopkins University School of Medicine, Baltimore, and The University of Pittsburgh School of Medicine, Pittsburgh

During the past 15 years we have managed six children with capillary hemangiomas in association with consumptive coagulopathy—the Kasabach-Merritt syndrome. Their ages when first seen ranged from 2 weeks to 4 years with a mean of 19 months. In three of the patients, the hemangiomas remained small for many months and then suddenly enlarged and hemorrhagic diatheses appeared. The duration of the thrombocytopenia ranged from 5 to 20 months, a time span that in some of the patients was influenced by the type of treatment used. Each patient received a variety of therapies including the following: medications to control the coagulopathy; mechanical, cytolytic, and pharmacologic treatment to eradicate the lesion; and blood product support with platelets and cryoprecipitate for severe bleeding. A prompt elevation of the platelet count occurred in three of the patients after the lesion was biopsied. Subtotal resection of the lesion resulted in an immediate increase of the platelet count in one patient. A transient increase in platelet counts and fibrinogen levels was observed in another patient following several embolizations of a portion of the hemangioma. Other modes of therapy were difficult to evaluate, especially because the same therapy applied at different times in the same patient effected a different type of response. Eventually, all of the patients experienced resolution of their lesions and, with this, concomitant reversal of the coagulopathy.

Key Words: Kasabach-Merritt syndrome • capillary hemangioma • thrombocytopenia • consumptive coagulopathy • microangiopathic hemolytic anemia

Submitted on May 23, 1986
Accepted on July 17, 1986




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