Kaposiform vascular tumors with Kasabach-Merritt phenomenon: a case series of KHE and KLA from a tertiary care center in India.

UNLABELLED: Kasabach-Merritt phenomenon (KMP) is a triad of microangiopathic hemolytic anemia, thrombocytopenia, and profound hypofibrinogenemia and it denotes the presence of underlying Kaposiform hemangioendothelioma (KHE)/Tufted angioma (TA). Kaposiform lymphangiomatosis is associated with moderate thrombocytopenia and hypofibrinogenemia and usually presents with hemorrhagic pleural and pericardial effusion. Medical management with a combination of drugs such as steroids, vincristine, propranolol, and sirolimus along with cryoprecipitate transfusion and restricted platelet transfusion is the cornerstone of management in most cases. As angiogenesis is due to the vascular endothelial growth factor (VEGF), especially VEGFA/VEGFR1, anti-VEGF inhibitors can be tried in Kaposiform hemangioendothelioma in refractory cases. We analyzed five children who presented with features of Kasabach-Merritt phenomenon and one child with "KMP like", who on further evaluation was found to have underlying vascular tumors. The most common treatment regimen was steroids with vincristine and the addition of sirolimus. One refractory case required bevacizumab and one child who had a central-conducting abnormality with pleural effusion with diffuse splenic involvement required splenectomy.

CONCLUSION

A child with microangiopathic hemolytic anemia with consumptive coagulopathy should be evaluated for underlying Kaposiform hemangioendothelioma and in the presence of pleural and pericardial effusion with "KMP-like" features there could be underlying Kaposiform lymphangiomatosis (KLA) and should be treated promptly with medical management and supportive care.

WHAT IS KNOWN: • A child with microangiopathic hemolytic anemia with consumptive coagulopathy and thrombocytopenia think of Kasaback Merritt Phenomenon.

WHAT IS NEW: • Child who presents with hemorrhagic pleural eff usion and associated with central conducting lymphatic anomalies think of Kaposiform lymphangiomatosis(KLA).