To determine the risk factors associated with intracranial hemorrhage (ICH) in patients with acute leukemia (AL), verify the thrombocytopenia threshold that increases the risk of ICH, describe the prognosis, and propose preventive measures for these subjects. 

A case-control, retrospective, single-center study was conducted. The medical records of 547 patients between July 1999 and June 2024 were reviewed. A univariate logistic regression analysis was performed to evaluate the correlation of various risk factors with ICH in patients with AL. A descriptive analysis of the prognosis was performed.

Nine percent of patients had ICH. Women accounted for a higher proportion of ICH cases (57.1%), but the difference in gender distribution was not significant. Most ICH cases were observed in patients with acute myeloid leukemia (42.9%) and acute lymphoblastic leukemia (40.8%). Identified risk factors for ICH were: hyperleukocytosis (OR= 3.504, 95% CI: 1.658–7.405), infection at the time of ICH (OR= 2.255, 95% CI: 1.091–4.66), smoking (OR= 2.648, 95% CI: 1.198–5.856), and lower platelet counts (0-4999 /µL: OR= 2.255, 95% CI: 1.091–4.66), identifying a platelet threshold of 5000 /µL. Patients who experienced ICH had a higher mortality rate (79.6% vs. 63%). Most ICH patients had an unfavorable functional prognosis on the modified Rankin scale, with 65.3% achieving a score of 6 (death). The average survival after ICH was 49 days.

This is the first Latin American case series published on ICH in AL. We identified modifiable risk factors that could be treated to prevent ICH. Strategies such as platelet transfusions starting from 5000 /µL and proactive infection management, could improve outcomes.