Recurrent Hemarthrosis Revealing Acquired Platelet Dysfunction in a Patient With Chronic Lymphocytic Leukemia: A Case Report and Literature Review

This is the authors' abstract. We don't add key points for this paper.

Hemorrhagic manifestations in chronic lymphocytic leukemia (CLL) are generally attributed to thrombocytopenia, autoimmune cytopenias, coagulation abnormalities, or treatment-related complications.Acquired platelet dysfunction remains a rare and underdiagnosed cause of bleeding.We report a case of a 79-year-old female with Binet stage A CLL who was under active surveillance and developed recurrent spontaneous hemarthrosis of the right knee associated with rectal bleeding.Laboratory investigations revealed persistent lymphocytosis, macrocytic anemia, and moderate thrombocytopenia (111-143 × 10⁹/L).Coagulation tests were normal.Platelet function test, performed twice by platelet aggregometry, demonstrated acquired platelet dysfunction characterized by major abnormalities in aggregation induced by arachidonic acid and ristocetin, with variable responses between the two studies.Acquired von Willebrand syndrome was considered unlikely.The patient was receiving dabigatran; however, hemarthrosis persisted despite discontinuation of anticoagulation, suggesting an underlying qualitative platelet dysfunction.This case highlights acquired platelet dysfunction as a rare but clinically relevant cause of bleeding in patients with CLL, whether receiving treatment or under surveillance.In patients presenting with unexplained bleeding despite preserved or only moderately reduced platelet counts and normal coagulation tests, platelet function testing should be considered.Recognition of this underdiagnosed complication may improve diagnostic accuracy and guide appropriate therapeutic management.