Acute lower limb ischemia as the initial symptom of acute myeloid leukemia

Kafetzakis, Alexandros; Foundoulakis, Andreas; Ioannou, Christos V.; Stavroulaki, Emily; Koutsopoulos, Anastasios; Katsamouris, Asterios

doi:10.1177/1358863x07080630

Cited by 21 publications

(23 citation statements)

References 11 publications

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“…Embolism of periphery arteries with ischemic lesion of corresponding extremities is reported in some clinical cases [4]. Priapism in male patients due to leukostasis represents a special emergency situation.…”

Section: Basic Principlesmentioning

confidence: 99%

Leukocyte Depletion by Therapeutic Leukocytapheresis in Patients with Leukemia

Hölig

Moog

2012

Transfus Med Hemother

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Hyperleukocytosis is a complication of various leukemias and can result in life-threatening leukostasis. Critical white blood cell (WBC) counts are conventionally defined as higher than 100 × 10⁹/l in acute myeloid leukemia and > 300 × 10⁹/l in acute lymphatic leukemia and other leukemic disorders (e. g. chronic myeloid leukemia). Leukocytapheresis is a therapeutic tool to reduce leukocyte counts in patients with symptomatic or threatening leukostasis until induction chemotherapy works. In patients with temporary contraindications against cytotoxic drugs, e.g. during pregnancy, leukocytapheresis can be used as a bridging therapy until conventional chemotherapy can be started. Therapeutic leukocytapheresis should be performed in specialized centers by experienced, well-trained staff. Thorough monitoring of the patients is extremely relevant. During a single procedure, WBC count can be reduced by 10–70%. Treatment should be repeated daily and can be discontinued when the symptoms of leukostasis have been resolved and/or leukocyte counts have fallen below the critical thresholds. There are no prospective studies evaluating the clinical efficacy of therapeutic leukocytapheresis in patients with hyperleukocytosis. It can be concluded from retrospective studies that leukocytapheresis might have some beneficial effect in early morbidity and mortality of patients with newly diagnosed AML but has no influence on overall long-term survival. Induction chemotherapy is the most important treatment in these patients and must never be postponed.

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Section: Basic Principlesmentioning

confidence: 99%

Leukocyte Depletion by Therapeutic Leukocytapheresis in Patients with Leukemia

Hölig

Moog

2012

Transfus Med Hemother

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“…De Stefano et al [3] reported that there were 6.3% people caught by thrombosis, 80% by venous thrombosis, and 20% by with arterial [3]. As far as we know, only nine cases of acute leukemia that presents to be acute lower limb ischemia caused by large artery occlusion have been traced in English literatures [4]. They include two cases in ALL, four cases in APL, and three cases in non-M3 AML patients.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2018

HTIJ

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Objective Summarized clinical characteristics of aortic thrombosis in patients with leukemia. Method Analysis of a case with aortic thrombosis as the first clinical features, treatment and prognosis of leukemia. Results recommend active anticoagulant therapy in combination with induction chemotherapy in patients with leukemia complicated by thrombosis. This approach would prevent recurrence of thrombosis while treating the underlying leukemia, resulting in improved patient outcomes.

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“…Hyperleukocytosis occurs in 5–13% of adult AML, especially in FAB M4 and M5 subtypes . These myeloblasts tend to be larger and less deformable , causing sluggish blood flow within the microcirculation, obstruction of microchannels, and formation of blast aggregates . There is also increased expression of adhesion molecules and endothelial cell production of cytokines that recruit additional myeloblasts, contributing to thrombus formation .…”

Section: Discussionmentioning

confidence: 99%

Blue toes and a new pair of shoes—Challenges in diagnosis and treatment of acute myelogenous leukemia

et al. 2013

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CaseA 63-year-old Caucasian female presented to the emergency department complaining of right foot pain for one day associated with blue toe discoloration for 3 weeks. She initially attributed her symptoms to trauma from a new pair of shoes but became concerned with the onset of pain. Her past medical history included hypertension and cervical cancer treated with hysterectomy 25 years ago. Her family history was noncontributory. She had a 40-pack year smoking history but quit 5 years ago. She was in good health prior to this presentation with an ECOG score of 0. Physical examination was remarkable for a weak right dorsalis pedis pulse and cyanosis of all toes on the right foot.Although a new pair of shoes is a potential explanation for developing blue toes, arterial thrombosis must be ruled out. Interestingly, the patient doesn't seem to have any reported cardiovascular risk factors or a known hypercoagulable state. It is reassuring that she is otherwise healthy and has a good performance status. We need to quickly identify the site of thrombosis and initiate prompt therapy in order to salvage the limb. It is also important to investigate the reason behind thrombus formation.Initial laboratory analysis was as follows: white cell count, 14,400/mL with 85% neutrophils, 7% lymphocytes, 7% monocytes, and 1% basophils; hemoglobin, 13.1 g/dL; mean corpuscular volume, 89 fL; platelets, 86,000/mL; international normalized ratio (INR), 1.5 [normal, 0.8-1.2]; activated partial thromboplastin time (aPTT), 29 sec [normal, 24-35 sec]; blood urea nitrogen (BUN), 18 mg/dL [normal, 8-24 mg/dL]; and creatinine, 2.0 mg/dL [normal, 0.6-1.2 mg/dL]. Peripheral smear showed granulocytosis with left shift but no blasts, 11 schistocytes, and moderate thrombocytopenia (Fig. 1a). The patient was admitted to the surgical service and empirically started on therapeutic-dose heparin drip and intravenous hydration. Arterial lower extremity Doppler showed small vessel occlusive disease without evidence of large vessel thrombosis. Abdominal vascular ultrasound and CT abdomen without contrast were unremarkable. At this time, anticoagulation was stopped. Hematology consult was called for evaluation of thrombocytopenia.Due to the patient's elevated creatinine, more sensitive imaging with contrast was not immediately performed. Although the culprit clot has not been identified, major arterial thrombosis remains high on the differential. Small vessel occlusive disease is unlikely to fully explain the patient's presentation. Her leukocytosis with left shift could represent a reactive process in response to acute inflammation. She also has evidence of coagulopathy, moderate thrombocytopenia, renal dysfunction, and presence of mild schistocytosis on peripheral smear. Differential diagnosis is broad and may include infection, vasculitis, autoimmune connective tissue disorder, and malignancy. Disseminated intravascular coagulation (DIC) with thrombocytopenia from platelet consumption and small renal infarcts is also a possibility. Thrombotic thrombocyto...

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Acute lower limb ischemia as the initial symptom of acute myeloid leukemia

Cited by 21 publications

References 11 publications

Leukocyte Depletion by Therapeutic Leukocytapheresis in Patients with Leukemia

Leukocyte Depletion by Therapeutic Leukocytapheresis in Patients with Leukemia

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Blue toes and a new pair of shoes—Challenges in diagnosis and treatment of acute myelogenous leukemia

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