Percutaneous hepatic perfusion with melphalan in liver metastatic uveal melanoma and viscoelastic hemostatic assays guided coagulation assessment for thrombocytopenia

Abstract

Thrombocytopenia is a well-documented hematologic consequence in patients undergoing percutaneous hepatic perfusion (PHP) to treat hepatic metastases secondary to ocular melanoma. In this case, four sequential PHP procedures resulted in significant thrombocytopenia, reaching 92, 75, 64, and 68% of baseline values. The thrombocytopenia was transient and spontaneously resolved within weeks. During the third procedure, a rotational thromboelastometry analysis was performed. We observed no clinically significant bleeding events, and rotational thromboelastometry analysis demonstrated a modest 11% reduction in maximum clot firmness, indicating preserved hemostatic function. These findings suggest that thrombocytopenia associated with PHP does not necessarily result in clinically relevant bleeding, and prophylactic platelet transfusion may not be warranted. Instead, perioperative coagulation monitoring utilizing viscoelastic hemostatic assays provide a dynamic, real-time assessment of hemostatic integrity, facilitating goal-directed perioperative management and intervention during PHP.

Keywords: coagulation management; melphalan; percutaneous hepatic perfusion; rotational thromboelastometry; thrombocytopenia; uveal melanoma.