Acute arterial thrombosis in acute promyelocytic leukaemia

Abstract

Unexpected limb ischaemia in a young, apparently healthy patient might be the presenting symptom of an underlying haematological disorder such as APL. A thorough haematological investigation should be performed prior to contemplating surgery. New treatment strategies based on knowledge of the molecular biology of APL has improved the prognosis of patients suffering from APL.

A Case of Ischemic Stroke in Acute Promyelocytic Leukemia at Initial Presentation: Relevance of All-Trans Retinoic Acid Treatment

“…We have reviewed the literature on the coagulopathy of this malignant haematological disorders: our search has revealed eight other case reports of arterial thrombosis as the presenting feature of APL; in these reports the thrombus affected prevalently the iliac, femoral and popliteal arteries, the pulmonary artery, the carotid and the middle cerebral arteries [15][16][17][18][19][20][21][22]. In an observational cohort study, the incidence of venous thromboembolism at diagnosis was 3.2% in APL patients and the clots were localized in deep venous of the leg [23].…”

“…Large blood vessel thrombosis as a presentation of APL is uncommon, as bleeding manifestations tend to predominate [15]. We have reviewed the literature on the coagulopathy of this malignant haematological disorders: our search has revealed eight other case reports of arterial thrombosis as the presenting feature of APL; in these reports the thrombus affected prevalently the iliac, femoral and popliteal arteries, the pulmonary artery, the carotid and the middle cerebral arteries [15][16][17][18][19][20][21][22].…”

Acute Promyelocytic Leukemia Treated With Idarubicin Complicated by Focal Segmental Glomerulosclerosis

“…15,16 Cancer patients are prone to thrombohemorrhagic complications, however, cases with thromboembolic events such as arterial occlusion localized to the large vessels at presentation are rare and almost all are related with APL in literature. 17 The pathogenesis of APLrelated prothrombotic state is complex and several mechanisms may play role: release of procoagulants by tumor cells (tissue factor and cancer procoagulant) which may be the cause of DIC and use of ATRA therapy which can induce a state of hypercoagulability exacerbated by tranexamic acid, 18 central venous catheters, 19 and hyperleukocytosis. 20 Treatment of APL with ATRA may lead to terminal differentiation of the leukemic cells by interaction with t (15,17) gene product.…”

“…17 The pathogenesis of APLrelated prothrombotic state is complex and several mechanisms may play role: release of procoagulants by tumor cells (tissue factor and cancer procoagulant) which may be the cause of DIC and use of ATRA therapy which can induce a state of hypercoagulability exacerbated by tranexamic acid, 18 central venous catheters, 19 and hyperleukocytosis. 20 Treatment of APL with ATRA may lead to terminal differentiation of the leukemic cells by interaction with t (15,17) gene product. This may induce rapid amelioration of the coagulopathy and produce a down-regulation of the procoagulant substances expressed by APL cells.…”

“…This may induce rapid amelioration of the coagulopathy and produce a down-regulation of the procoagulant substances expressed by APL cells. 17 Despite rapid correction of the coagulopathy, leukemic cells may favor development of prothrombic events because hyperfibrinolysis is reduced before procoagulation. 21 Internal carotid artery thrombosis is rare and was previously described due to DIC.…”