Kachhwaha Arjun, Shah Bibhant, Ronanki Kavya, Dalton Prisla Maria, Nath Uttam Kumar
Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, India.
Cardiovasc Hematol Disord Drug Targets. 2024;24(4):266-270. doi: 10.2174/011871529X334859241016114027.
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.
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.
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.
实体恶性肿瘤合并血栓栓塞是常见的相关特征，在血液系统恶性肿瘤中则较少见。由弥散性血管内凝血（DIC）导致的血栓形成事件典型地与某些血液系统恶性肿瘤相关（例如，急性早幼粒细胞白血病（APL））。以广泛血栓栓塞为表现的急性髓系白血病（AML）并非常见的临床表现。对这些患者亚组进行抗凝治疗仍然是一项重大挑战，因为患者常常有血小板减少和出血表现，需要密切监测。
一名54岁男性，已知患有缺血性心脏病，正在接受常规抗血小板治疗，因急性起病的进行性气短伴轻度贫血就诊。进一步评估后，该患者被诊断为双侧肺动脉和静脉血栓形成，以及左肾完全性和下腔静脉部分性血栓形成。患者血小板计数正常，安全地开始了抗凝治疗。后来，外周血涂片和流式细胞术免疫表型分析确诊为急性髓系白血病，患者开始接受治疗。
急性髓系白血病初诊时出现广泛的动静脉血栓形成是一种罕见的表现，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维持足够的血小板计数，尤其是在血液系统恶性肿瘤患者中。
