AML M1 presenting with recurrent acute large arterial vessel thromboembolism
Department of Hematology/Oncology, Medizinische Klinik Innenstadt, University Hospital Munich, Ziemssenstrasse 1, D-80336 Munich, Germany.Leukemia Research (Impact Factor: 2.35). 07/2007; 31(6):869-71. DOI: 10.1016/j.leukres.2006.08.010
Acute leukemia may be associated with coagulopathy, predominantly severe bleeding diathesis caused by disseminated intravascular coagulation (DIC) and/or hyperfibrinolysis. Disordered hemostasis is characteristic for acute promyelocytic leukemia (APL, FAB M3). However, thromboembolic events such as arterial occlusion localized to the large vessels at presentation is very rare and almost exclusively linked to APL. We report a case of severe recurrent acute arterial thromboembolism at presentation in AML FAB M1. Most likely, the ischemic events in our patient resulted from leukemia as the thrombus material included many leukemic blasts. The thrombotic complications resulted in leg amputation in this patient. Despite leg amputation just a couple of hours before and extremely high infectious risk of the patient, chemotherapy was administered. The clinical course of cessation of the ischemic events and a fast reduction of the blasts in the peripheral blood smear after chemotherapeutic treatment of the patient outlines the importance and life saving role of early chemotherapy even under adverse circumstances.
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ABSTRACT: Si les manifestations hémorragiques, les thromboses des petits vaisseaux, constituent des formes habituelles de révélation des leucémies aiguës, les occlusions des artères de gros calibres en présentent une complication rare. Nous présentons l’observation d’un patient de 41 ans, admis pour ischémie aiguë du membre inférieur gauche sur occlusion de l’artère poplitée, révélant une leucémie aiguë promyélocytaire. Le mécanisme de thrombose était une leucostase. Une thrombectomie fémoropoplitée a été réalisée avec complément de chimiothérapie. L’évolution était favorable.
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ABSTRACT: Acute myeloid leukemia (AML) is usually associated with coagulopathy and disorders of hemostasis, but cases of ischemic events have been reported. We present a case of AML with recurrent acute limb ischemia and multiple organ infarctions. A 57-year-old woman diagnosed with AML subtype M1 developed recurrent bilateral acute lower-limb ischemia refractory to multiple thromboembolectomies and bypass grafting. Histopathology revealed that thrombi were composed of leukemic blasts, and computed tomography angiogram incidentally revealed multiple infarctions. She demonstrated a response to chemotherapy, but died of an overwhelming sepsis 22 days after her acute admission. AML subtype M1 with acute lower-limb ischemia and multiple organ infarctions is associated with a poor prognosis. The role of emergency chemotherapy in reducing the tumour burden and possibly improving the results of vascular interventions needs to be defined. Limb-salvaging surgery should not be delayed but be administered immediately according to the degree of ischemia.
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