• Determine the effect of sargramostim (GM-CSF) on the progression-free 1-year survival of patients with myelodysplastic syndrome who have undergone T-cell-depleted CD34+ augmented allogeneic bone marrow transplantation. (knowcancer.com)
  • The pathogenesis of myelodysplastic syndrome (MDS) may be related to the abnormal expression of microRNAs (miRNAs), which could influence the differentiation capacity of mesenchymal stem cells (MSCs) towards adipogenic and osteogenic lineages. (techscience.com)
  • Bone marrow loss and a high proclivity to leukemic progression are the characteristics of myelodysplastic syndrome (MDS). (techscience.com)
  • The workup in patients with possible myelodysplastic syndrome (MDS) includes a complete blood count with differential, peripheral blood smear, and bone marrow studies. (medscape.com)
  • Additional tests, as well as genetic testing may be ordered to rule out other inherited conditions, such as myelodysplastic syndrome (MDS) . (childrenshospital.org)
  • After a 10-year-old patient was diagnosed with Myelodysplastic Syndrome based on bone marrow biopsy, the patient was referred to Maddie's Vision Centre of Research Excellence executive member Dr Lucy Fox for genomic investigation as part of the EMBRACE study. (mrv.org.au)
  • The EMBRACE team confirmed an underlying diagnosis of Shwachman Diamond Syndrome, which had predisposed the child to developing Myelodysplastic Syndrome. (mrv.org.au)
  • What is Myelodysplastic Syndrome? (lymphomainfo.net)
  • Myelodysplastic syndrome (MDS) comprises a heterogeneous group of clonal disorders of haematopoietic stem cells, characterised by dysplastic haematopoiesis and dysregulated apoptosis resulting in various degrees of cytopenia, whereas canonical cytologic, cytogenetic and histopathologic findings guiding the diagnosis MDS are widely accepted, the MDS-phenotype can be masked by coexisting/paraneoplastic immunologic disease. (researcher.life)
  • As paraneoplastic syndromes are often mistakenly diagnosed as idiopathic autoimmune disorders, we propose that coexistence of an underlying myelodysplastic syndrome should be considered early in the diagnostic work up. (researcher.life)
  • A Comparative Analysis of Outcomes in Primary Myelodysplastic Syndrome (MDS) and Therapy-Related MDS Reveals Two Subgroups with Differing Risk Profiles: Implications for the Application of a Prognostic Classification. (researcher.life)
  • Myelodysplastic syndrome (MDS) can be difficult to diagnose. (mskcc.org)
  • What Are the Current Treatment Options for Myelodysplastic Syndrome? (healthline.com)
  • Myelodysplastic syndrome (MDS) refers to a group of bone marrow disorders that interfere with the healthy production of blood cells. (healthline.com)
  • Chronic benzene exposure results in progressive depression of bone marrow function with increased risks of aplastic anemia, myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), chronic lymphocytic leukemia, and other disorders. (cdc.gov)
  • Give a new life to Debasmita Dutta(5 yrs) for Bone-Marrow Transplant. (milaap.org)
  • They might involve medicines, blood transfusions or a bone marrow transplant . (medlineplus.gov)
  • WU polyomavirus (WUPyV) was detected in a bone marrow transplant recipient with severe acute respiratory distress syndrome who died in 2001. (cdc.gov)
  • That study determined that WUPyV was present in epithelial cells from a bronchoalveolar lavage from a lung transplant recipient with Job syndrome. (cdc.gov)
  • Eligibility includes having developed cytopenias (reduced blood cell counts) and not having an HLA-identical matched sibling donor for bone marrow transplant (BMT). (fanconi.org)
  • Create healthcare diagrams like this example called Diseases Treatable with a Bone Marrow or Cord Blood Transplant in minutes with SmartDraw. (smartdraw.com)
  • When lymphoma proves especially difficult to treat, doctors may perform a bone marrow transplant , either from the patient or from a donor. (lymphomainfo.net)
  • The hope in such a transplant is to remake the bone marrow so that it can build a new immune system following high-dose chemotherapy and radiation that is designed to kill all the cancer cells in the body. (lymphomainfo.net)
  • Since this process kills the bone marrow too, a transplant is necessary. (lymphomainfo.net)
  • p>A blood and bone marrow transplant takes unhealthy stem cells out of the bone marrow and replaces them with healthy stem cells, with the intent to treat childhood cancers and nonmalignant blood and bone marrow diseases. (nemours.org)
  • While bone-marrow transplantation might mitigate hematopoietic syndrome, currently there are no approved medical countermeasures to alleviate radiation-induced gastrointestinal syndrome (RIGS), resulting from direct cytocidal effects on intestinal stem cells (ISC) and crypt stromal cells. (elsevierpure.com)
  • We examined whether bone marrow-derived adherent stromal cell transplantation (BMSCT) could restitute irradiated intestinal stem cells niche and mitigate radiation-induced gastrointestinal syndrome. (elsevierpure.com)
  • Methodology/Principal Findings: Autologous bone marrow was cultured in mesenchymal basal medium and adherent cells were harvested for transplantation to C57Bl6 mice, 24 and 72 hours after lethal whole body irradiation (10.4 Gy) or abdominal irradiation (16-20 Gy) in a single fraction. (elsevierpure.com)
  • Conclusion/Significance: Mitigation of lethal intestinal injury, following high doses of irradiation, can be achieved by intravenous transplantation of marrow-derived stromal cells, including mesenchymal, endothelial and macrophage cell population. (elsevierpure.com)
  • Hematopoietic stem cell transplantation remains the only curative therapeutic approach that reliably results in resolution of bone marrow fibrosis in patients with myelofibrosis. (haematologica.org)
  • On behalf of the European School of Haematology and the Severe Aplastic Anaemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT), we are very pleased to invite you to this Translational Research Conference on Bone Marrow Failure Syndromes (BMFS). (esh.org)
  • Poor graft function ( PGF ), manifested by multilineage cytopenias and complete donor chimerism post-allogeneic stem cell transplantation (alloSCT), and acquired aplastic anaemia (AA) are immune-mediated acquired bone marrow (BM) failure syndromes with a similar clinical presentation. (bvsalud.org)
  • Chronic GVHD (cGVHD) associated bronchiolitis obliterans syndrome (BOS) is a serious complication after allo-SCT, and lung transplantation (LTx) may be the ultimate treatment option. (nih.gov)
  • Transfers are most likely to a bone marrow transplantation unit for stem cell reconstitution. (medscape.com)
  • Cutaneous manifestations in patients with Wiskott-Aldrich syndrome submitted to haematopoietic stem cell transplantation. (medscape.com)
  • The stromal cell requirement for androgen-mediated effects was confirmed in vivo by experiments using chimeric animals created by bone marrow transplantation in which androgen receptor expression was restricted to either the stromal or lymphoid cells of the bone marrow. (jci.org)
  • p>In addition to childhood cancers and blood disorders, Nemours treats nonmalignant bone marrow disorders, immune system deficiencies and some metabolic disorders with allogeneic blood and bone marrow transplantation. (nemours.org)
  • The inherited bone marrow failure syndromes (IBMFS) include Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, and other genetic disorders. (medscape.com)
  • Bone Marrow Failure Syndromes are a group of blood disorders. (petermac.org)
  • The 'Inherited Bone Marrow Disorders' panel test comes into play here. (petermac.org)
  • The bone marrow failure syndromes comprise a group of disorders than can be either inherited or acquired. (medscape.com)
  • These diseases are intrinsic disorders of the bone marrow involving disruption in the homeostasis and function of hematopoietic stem cells, resulting in inadequate production of either a single or multiple cell lines (erythroid for red cells, myeloid for white blood cells, megakaryocytic for platelets). (medscape.com)
  • The Dana-Farber/Boston Children's Cancer and Blood Disorders Center has a long history of research and innovation associated with bone marrow failure conditions. (childrenshospital.org)
  • INTRODUCTION THE MYELODYSPLASTIC syndromes (MDS) are a group of haematological disorders characterized by dysplasia in the h a e m a t o p o i e t i c cell lines [1]. (docksci.com)
  • For instance, identification of MYH9 as the gene whose mutations cause the May-Hegglin anomaly led to the recognition that Sebastian platelet syndrome, Epstein syndrome, and Fechtner syndrome derive from mutations of the same gene and describe overlapping disorders. (nih.gov)
  • Looking at the chromosomes of the cells in the blood and bone marrow shows specific abnormalities that help doctors tell the difference between MDS and other blood disorders. (cancer.net)
  • Orthopedists (bone specialists) and orthopedic surgeons at Nemours Center for Cancer and Blood Disorders make our pediatric orthopedics programs among the largest and most respected in the world. (nemours.org)
  • Calcium folinate rescue has to be performed by parenteral administration in patients with malabsorption syndromes or other gastrointestinal disorders where enteral absorption is not assured. (janusinfo.se)
  • Outflow obstruction caused by the sinusoidal obstruction syndrome (formerly 'veno-occlusive disease') and cardiac disorders is excluded. (medscape.com)
  • The bone marrow stromal cell (BMSC) population, which makes up a large part of the hematopoietic microenvironment, encompasses a variety of adherent cell types. (techscience.com)
  • Preparation of cells Bone marrow cells were obtained by aspiration into sterile tubes containing 2 ml Iscove's modified Dulbecco's medium (IMDM) (Gibco) with 200 IU preservative-free heparin. (docksci.com)
  • A bone marrow aspiration should be performed as part of the same procedure. (bmj.com)
  • A bone marrow aspiration removes a sample of the fluid with a needle. (cancer.net)
  • Although bone marrow fibrosis is seen in a variety of malignant and non-malignant disease states, the deposition of reticulin and collagen fibrosis in the bone marrow of patients with myelofibrosis is believed to be mediated by the myelofibrosis hematopoietic stem/progenitor cell, contributing to an impaired microenvironment favoring malignant over normal hematopoiesis. (haematologica.org)
  • Bone marrow is where B-cells are selected, developed and matured in a process called hematopoiesis. (lymphomainfo.net)
  • In 30-50% of patients, the lymphoblasts infiltrate bone marrow, causing ineffective hematopoiesis. (medscape.com)
  • Bone Marrow Failure Syndromes (BMFS) happens when our bone marrow does not make enough working blood cells. (petermac.org)
  • Knowing the exact genetic cause of bone marrow failure syndrome is valuable. (petermac.org)
  • A potential strategy to treat a rare bone marrow failure syndrome has been reported by researchers in the USA. (b-s-h.org.uk)
  • Research led by Washington University School of Medicine in St. Louis, USA, says the strategy for poikiloderma with neutropenia could also have implications for treating other bone marrow failure syndromes with similar underlying dysfunctions. (b-s-h.org.uk)
  • Although it was known that poikiloderma with neutropenia is caused by mutations in a gene called USB1 , the precise mechanism of how the mutation causes bone marrow failure was unknown. (b-s-h.org.uk)
  • PAPD5 inhibition is poised to be a potential treatment for other bone marrow failure syndromes. (b-s-h.org.uk)
  • [ 1 ] The most common cause of acquired bone marrow failure is aplastic anemia . (medscape.com)
  • Diseases that can present in a manner similar to acquired bone marrow failure include myelodysplastic syndromes , paroxysmal nocturnal hemoglobinuria , and large granular lymphocytic leukemia . (medscape.com)
  • Bone marrow failure can be either inherited or acquired and can involve a single hematopoietic stem cell line or all three cell lines. (medscape.com)
  • 2022-2024 (Grant): Manage the Australian Aplastic Anaemia and other Bone Marrow Failure Syndrome Registry. (mrv.org.au)
  • The Australian Bone Marrow Failure Biobank. (mrv.org.au)
  • 2020-2023 (Grant): The Australian Bone Marrow Failure Biobank. (mrv.org.au)
  • Maddie's Vision periodically offer Grant Rounds to build capacity and support outstanding researchers in the areas of Bone Marrow Failure Syndromes. (mrv.org.au)
  • Our basic science and clinical research program offers unique access to clinical trials in which children can receive the newest bone marrow failure diagnostic evaluations and treatments. (childrenshospital.org)
  • With the support of funding from the National Institutes of Health , we established a nationwide Pediatric Bone Marrow Failure and MDS Registry. (childrenshospital.org)
  • 6 Causes of early death include leukemic transformation, complications arising from progressive bone marrow failure, portal/pulmonary hypertension, infections, thrombosis and bleeding. (haematologica.org)
  • These diseases can often cause bone marrow failure and lung disease. (childrenshospital.org)
  • Eventually, most people with DC will develop bone marrow failure. (childrenshospital.org)
  • The Maddie Riewoldt's Vision-funded Evaluating MultidisciplinaRy Bone maRrow fAilure CarE (EMBRACE) study has provided over 400 Australians with Bone Marrow Failure Syndromes access to an evidenced-based model of care that provides tailored treatment targeted to their individual needs. (mrv.org.au)
  • EMBRACE measures the impact of providing Australian patients with bone marrow failure an accurate genetic diagnosis, up-to-date and comprehensive information about the disease, and access to expert care, treatment and the opportunity to participate in research. (mrv.org.au)
  • One of the most crucial steps in treating patients with Bone Marrow Failure Syndromes is determining an accurate diagnosis so patients can access the treatment they need as soon as possible. (mrv.org.au)
  • Different Bone Marrow Failure Syndromes can be impossible to distinguish on standard laboratory assessments, and complex genetic testing is required to reach the correct diagnosis. (mrv.org.au)
  • Thanks to the EMBRACE study, the patient will receive life-long care which takes into account his underlying Bone Marrow Failure Syndrome. (mrv.org.au)
  • The EMBRACE study is a groundbreaking project that is changing the way we treat Bone Marrow Failure Syndromes in Australia. (mrv.org.au)
  • This is the most exciting research news for patients with inherited bone marrow failure. (mrv.org.au)
  • On October 13-15, the Maddie Riewoldt's Vision Centre of Research Excellence in Bone Marrow Biology was proud to host the 3rd National Symposium on Bone Marrow Failure Syndromes. (mrv.org.au)
  • The meeting will be of particular value for clinicians and non-clinical scientists, M.D. and Ph.D. of all ages interested in the biology, pathophysiology, diagnosis and treatment of bone marrow failure syndromes (BMFS). (esh.org)
  • Constitutional marrow failure 3: telomere biology diseases and other. (esh.org)
  • Spatial proteomics identifies a spectrum of immune dysregulation in acquired bone marrow failure syndromes. (bvsalud.org)
  • Utility of clinical comprehensive genomic characterisation for diagnostic categorisation in patients presenting with hypocellular bone marrow failure syndromes. (austin.org.au)
  • Bone marrow failure (BMF) related to hypoplasia of haematopoietic elements in the bone marrow is a heterogeneous clinical entity with a broad differential diagnosis including both inherited and acquired causes. (austin.org.au)
  • Monocentric report on clinical phenotypes found in MDS or bone marrow failure with paraneoplastic inflammatory disease. (researcher.life)
  • We report eight patients diagnosed with MDS or bone marrow failure, who presented with paraneoplastic autoimmune diseases. (researcher.life)
  • Patients living with bone marrow failure diseases and their families and caregivers should continue to practice social distancing, frequently wash and sanitize hands, wear masks around others, and encourage others to wear masks around you. (aamds.org)
  • As a person with a bone marrow failure condition, such as myelodysplastic syndromes (MDS), aplastic anemia , paroxysmal nocturnal hemoglobinuria (PNH), etc., you are already taking precautions to protect your compromised immune system. (aamds.org)
  • Patients with these diseases have been disproportionately affected by the COVID-19 pandemic with concerning mortality rates for patients who contract the virus and concerns about the efficacy of the available vaccines for bone marrow failure patients. (aamds.org)
  • A definitive diagnosis can be provided only after a specialist called a hematopathologist examines a sample of your bone marrow. (mskcc.org)
  • 20% lymphoblasts in marrow), a diagnosis of lymphoblastic lymphoma is made. (medscape.com)
  • Conversely, a diagnosis of ALL generally requires at least 20% lymphoblasts in marrow. (medscape.com)
  • The appearance of the bone marrow tissue, along with blood cell counts and chromosomal analysis (see below), is needed to confirm a diagnosis of MDS. (cancer.net)
  • The diagnosis, initial management and long-term follow-up of patients with Budd-Chiari syndrome is reviewed. (medscape.com)
  • If the white blood cells being made in the bone marrow are abnormal, that is characteristic of leukemia. (lymphomainfo.net)
  • Your doctor may recommend running laboratory tests on a bone marrow sample to identify mutations in specific genes, abnormal proteins, and other factors unique to MDS. (cancer.net)
  • X-linked lymphoproliferative syndrome is an immunodeficiency disorder that results from an abnormality in T cells and natural killer cells and results in an abnormal response to Epstein-Barr virus infection. (msdmanuals.com)
  • A small number of patients may have a hypocellular marrow. (medscape.com)
  • However, better understanding of the role of increased JAK-STAT signaling [either through activating mutations ( JAK2 , MPL515L/K ) within the signaling pathway, or mutations involving CALR ], the role of deregulated pro-inflammatory cytokine expression, and the impaired bone marrow microenvironment is transforming the treatment approach for MF. (haematologica.org)
  • Bone marrow is where our body makes all our blood cells (red, white and platelets). (petermac.org)
  • Furthermore, two types of marrow are found in bone marrow: red marrow, where blood cells and platelets come from, and yellow marrow, which has a high amount of fat cells and makes some white blood cells. (lymphomainfo.net)
  • A hereditary cancer syndrome (familial/family cancer syndrome, inherited cancer syndrome, cancer predisposition syndrome, cancer syndrome, etc.) is a genetic disorder in which inherited genetic mutations in one or more genes predispose the affected individuals to the development of cancer and may also cause early onset of these cancers. (wikipedia.org)
  • Hereditary cancer syndromes often show not only a high lifetime risk of developing cancer, but also the development of multiple independent primary tumors. (wikipedia.org)
  • Common examples of inherited cancer syndromes are hereditary breast-ovarian cancer syndrome and hereditary non-polyposis colon cancer (Lynch syndrome). (wikipedia.org)
  • Hereditary cancer syndromes underlie 5 to 10% of all cancers and there are over 50 identifiable hereditary forms of cancer. (wikipedia.org)
  • Scientific understanding of cancer susceptibility syndromes is actively expanding: additional syndromes are being found, the underlying biology is becoming clearer, and genetic testing is improving detection, treatment, and prevention of cancer syndromes. (wikipedia.org)
  • Given the prevalence of breast and colon cancer, the most widely recognized syndromes include hereditary breast-ovarian cancer syndrome and hereditary non-polyposis colon cancer (Lynch syndrome). (wikipedia.org)
  • Some rare cancers are strongly associated with hereditary cancer predisposition syndromes. (wikipedia.org)
  • Primary care physicians can identify people who are at risk of a hereditary cancer syndrome. (wikipedia.org)
  • Most cancer syndromes are transmitted in a mendelian autosomal dominant manner. (wikipedia.org)
  • Examples of autosomal recessive cancer syndromes are ataxia-telangiectasia, Bloom syndrome, Fanconi anemia, MUTYH-associated polyposis, Rothmund-Thomson syndrome, Werner syndrome and Xeroderma pigmentosum. (wikipedia.org)
  • Many scenarios, including infection, aberrant immunity, cancer and cancer immunotherapy, are associated with cytokine storm, also known as cytokine release syndrome (CRS) or hypercytokinaemia. (nature.com)
  • In January I was diagnosed with a Myloproliferative Neoplasm ( bone marrow cancer). (cancer.org)
  • Many of these syndromes are caused by mutations in tumor suppressor genes, genes that are involved in protecting the cell from turning cancerous. (wikipedia.org)
  • Shwachman-Diamond syndrome is an autosomal recessive disorder in which the majority of patients have a mutation in the Shwachman Bodian Diamond syndrome gene ( SBDS ), located at band 7q11. (medscape.com)
  • Less often, syndromes may be transmitted as an autosomal recessive trait. (wikipedia.org)
  • Morquio syndrome (mucopolysaccharidosis type IV [MPS IV]) is a rare lysosomal storage disease (LSD) that is inherited in an autosomal-recessive fashion. (medscape.com)
  • Bone marrow fibrosis is a central pathological feature and World Health Organization major diagnostic criterion of myelofibrosis. (haematologica.org)
  • Increased expression of inflammatory cytokines, lysyl oxidase, transforming growth factor-β, impaired megakaryocyte function, and aberrant JAK-STAT signaling have all been implicated in the pathogenesis of bone marrow fibrosis. (haematologica.org)
  • A number of studies indicate that bone marrow fibrosis is an adverse prognostic variable in myeloproliferative neoplasms. (haematologica.org)
  • However, modern myelofibrosis prognostication systems utilized in risk-adapted treatment approaches do not include bone marrow fibrosis as a prognostic variable. (haematologica.org)
  • The specific effect on bone marrow fibrosis of JAK2 inhibition, and other rationally based therapies currently being evaluated in myelofibrosis, has yet to be fully elucidated. (haematologica.org)
  • Here we review the pathogenesis, biological consequences, and prognostic impact of bone marrow fibrosis. (haematologica.org)
  • Bone marrow fibrosis (BMF) is characterized by the increased deposition of reticulin fibers and in some cases collagen fibers. (haematologica.org)
  • European consensus on the grading of bone marrow fibrosis. (haematologica.org)
  • Conditions associated with bone marrow fibrosis. (haematologica.org)
  • Increased marrow fibrosis may be confused with other MPDs. (medscape.com)
  • Suspected bone marrow fibrosis. (bmj.com)
  • OUTLINE: All patients receive elutriated, CD34+ stem cell augmented donor bone marrow according to another protocol on day 0. (knowcancer.com)
  • The actual clinical manifestations of a vesicant exposure may be more variable than the syndrome described above. (cdc.gov)
  • High early mortality rates and a high rate of complications in Wiskott-Aldrich syndrome suggest frequent monitoring by a clinical immunologist is essential. (medscape.com)
  • Candotti F. Clinical Manifestations and Pathophysiological Mechanisms of the Wiskott-Aldrich Syndrome. (medscape.com)
  • Clinical spectrum, pathophysiology and treatment of the Wiskott-Aldrich syndrome. (medscape.com)
  • In patients with clinical diagnoses of inherited BMF syndromes, acquired BMF syndromes or clinically unclassifiable BMF we detected variants in 52% (12/23), 53% (25/47) and 56% (25/45) respectively. (austin.org.au)
  • [ 11 ] In 1976, O'Brien et al reported a patient with a mild clinical status similar to Morquio A syndrome. (medscape.com)
  • Morphologic abnormalities are evident in nuclear-cytoplasm dissociation in maturation and when the pseudo-Pelger forms are also present in bone marrow. (medscape.com)
  • Although most individuals with Morquio syndrome appear normal at birth, skeletal abnormalities often develop within the first year of life. (medscape.com)
  • Budd-Chiari syndrome is a rare disorder caused by hepatic venous outflow obstruction and resulting hepatic dysfunction. (medscape.com)
  • Trephine biopsies of the bone marrow should be carried out, when clinically indicated, by trained individuals following a standard operating procedure. (bmj.com)
  • Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. (medlineplus.gov)
  • In the absence of vitamin B-12 or folate deficiencies, the bone marrow usually exhibits asynchronous maturation of nuclei and cytoplasm similar to that described in megaloblastic anemias. (medscape.com)
  • Cameron Lyle, 21, is a shot-putter at the University of New Hampshire who decided to give up his sport so that he could donate his bone marrow to a stranger with leukemia. (lymphomainfo.net)
  • The bone marrow is one of two primary lymphoid organs, along with the thymus. (lymphomainfo.net)
  • We employed in vitro cultures and two in vivo models to investigate whether androgens exert these effects directly on marrow lymphoid precursors or whether actions on marrow stromal elements are required. (jci.org)
  • Low T Cell Numbers Resembling T-B+ SCID in a Patient with Wiskott-Aldrich Syndrome and the Outcome of Two Hematopoietic Stem Cell Transplantations. (medscape.com)
  • We are also leading members of the North American Pediatric Aplastic Anemia Consortium (NAPAAC) and the Shwachman-Diamond Syndrome (SDS) Registry . (childrenshospital.org)
  • Bone marrow film (1000× magnification) demonstrating ring sideroblasts in Prussian blue staining in a refractory anemia with excess of blasts in transformation. (medscape.com)
  • If the bone marrow isn't making red blood cells, it is called aplastic anemia. (lymphomainfo.net)
  • In conclusion, genomic characterisation can improve diagnostic categorisation of patients presenting with hypoplastic BMF syndromes and should be routinely performed in this group of patients. (austin.org.au)
  • In general, admit a patient with Wiskott-Aldrich syndrome (WAS) with bleeding or pulmonary infection because the extent of bleeding may be difficult to ascertain or bleeding may be difficult to control. (medscape.com)