Bleeding in Congenital Hemangiomas: Crusting as a Clinical Predictive Sign and Usefulness of Tranexamic Acid
Article first published online: 13 OCT 2011
© 2011 Wiley Periodicals, Inc.
Volume 29, Issue 2, pages 182–185, March/April 2012
How to Cite
Powell, J., Blouin, M.-M., David, M. and Dubois, J. (2012), Bleeding in Congenital Hemangiomas: Crusting as a Clinical Predictive Sign and Usefulness of Tranexamic Acid. Pediatric Dermatology, 29: 182–185. doi: 10.1111/j.1525-1470.2011.01517.x
- Issue published online: 13 MAR 2012
- Article first published online: 13 OCT 2011
Abstract: We present two case reports of CH in which severe bleeding episodes occurred during the first weeks of life and report the use of topical tranexamic acid to control bleeding in this setting. Patient 1 was a full-term female infant who presented at birth with a large 7- by 6-cm CH of the forehead showing a few millimeter-sized crusts. No active treatment except close follow-up was advised. At 10 weeks of age, the size of the lesion having spontaneously decreased more than 50%, she presented with severe bleeding from a small crusted area. The bleeding was controlled using topical tranexamic acid, and except for a few minor, easily controlled bleeding episodes in the following weeks, the lesion regressed more than 80%. Patient 2 was a full-term male infant seen at 1 day of life for a 14- by 10-cm CH of the right knee with a few small, dark, superficial crusts. At 3 weeks of age, he was hospitalized after severe bleeding from one of the crusted areas, with a drop in hemoglobin from 131 to 114 g/L. Bleeding was controlled using topical tranexamic acid, and compressive dressing. Because the lesion was clinically a rapidly involuting CH, there was no need for embolization or surgery. The presence of crusting in CH, even in the absence of frank ulceration, is an ominous sign and can precede serious bleeding. Tranexamic acid, an antifibrinolytic agent that helps stabilize the clot, has proved useful topically in controlling bleeding in CH.