Aplastic anemia (AA) is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. Anemia, bleeding, and infection are usually presenting symptoms. Intracranial hemorrhage (IH) is a life-threatening complication of AA. We aim to examine laboratory and radiological findings in two patients with intracranial hemorrhage associated with AA and their therapeutic approach. Methods: A 12-year-old boy with a diagnosis of severe acquired AA was admitted to our hospital. After multiple bleeding episodes and febrile neutropenia he developed a spontaneous subdural hematoma without indication for surgical care. Medical treatment was initiated with eltrombopag, immunoglobulin plus methylprednisolone, platelet transfusion and FVII, FXIII and fibrinogen administration as needed. A 70-year-old woman with AA and priors of hypertension, atrial fibrillation and multiple bleeding events was admitted to our hospital after reporting a strong progressive headache, nausea and generalized lack of strength. CT brain imaging showed several cerebral micro-bleeding sites and a hemorrhage on the right cerebellar hemisphere. The chosen course of treatment was medical: immunoglobulin plus dexamethasone, eltrombopag, fibrinogen correction and platelet transfusion.

Three months later the boy's hematoma reabsorbed and he was refered for allogenic transplantation with hematopoietic progenitor cells. On the other hand, despite optimized medical treatment, the woman's intracranial bleed worsened with mass effect and deteriorated clinical status.

IH is a serious complication of pancytopenia in AA and should be treated as soon as the diagnosis is made. A detailed patient history and physical examination, as well as laboratory and radiological monitoring, are crucial to the management of intracranial bleeding in this context. In some cases, conservative treatment can be effective by correcting the thrombocytopenia and clotting factor levels.