Acute Myeloid Leukemia Presenting as Extensive Arterial and Venous Thrombosis: A Case Report.

Arjun Kachhwaha, Bibhant Shah, Kavya Ronanki, Prisla Maria Dalton, Uttam Kumar Nath
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Abstract

Background: Thromboembolism with solid malignancies is a commonly associated feature, which is less common in hematological malignancies. Disseminated intravascular coagulation (DIC) causing thrombotic events is characteristically associated with certain hematological malignancies (e.g., acute promyelocytic leukemia (APL). Acute myeloid leukemia (AML) presenting as extensive thromboembolism is not a common clinical presentation. Anticoagulation in these subsets of patients remains a major challenge since patients often have thrombocytopenia and bleeding manifestations, requiring close monitoring.

Case presentation: A 54-year-old male with a known case of ischemic heart disease on regular anti- platelet therapy presented with acute onset progressive shortness of breath with mild anemia. On further evaluation, the patient was diagnosed with bilateral pulmonary artery and venous thrombosis along with left complete renal and partial inferior vena cava (IVC) thrombosis. The patient was started safely on anticoagulant therapy with normal platelet counts. Later, peripheral smear and immunophenotyping by flow cytometry revealed the diagnosis of acute myeloid leukemia, and the patient started its treatment.

Conclusion: Extensive arterial and venous thrombosis at presentation of acute myeloid leukemia is an uncommon finding and needs anticoagulation therapy along with the treatment of the underlying disease. Close monitoring of bleeding and maintaining an adequate platelet count is required, especially in hematological malignancies.

急性髓性白血病表现为广泛的动脉和静脉血栓:病例报告。
背景:血栓栓塞是实体恶性肿瘤的常见特征,但在血液恶性肿瘤中并不常见。导致血栓事件的弥散性血管内凝血(DIC)是某些血液恶性肿瘤(如急性早幼粒细胞白血病(APL))的典型特征。急性髓性白血病(AML)出现广泛血栓栓塞的临床表现并不常见。这些亚群患者的抗凝治疗仍是一大挑战,因为患者通常有血小板减少和出血表现,需要密切监测:一名 54 岁的男性患者,已知患有缺血性心脏病,正在接受常规抗血小板治疗,因急性发作进行性气短伴轻度贫血而就诊。经进一步评估,患者被诊断为双侧肺动脉和静脉血栓形成,同时伴有左肾和部分下腔静脉(IVC)血栓形成。患者开始安全地接受抗凝治疗,血小板计数正常。后来,外周涂片和流式细胞术免疫分型显示,患者被诊断为急性髓性白血病,并开始接受治疗:结论:急性髓性白血病发病时出现广泛的动静脉血栓形成并不常见,需要在治疗基础疾病的同时进行抗凝治疗。需要密切监测出血情况并保持足够的血小板数量,尤其是血液恶性肿瘤患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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