Thromboembolic and bleeding complications in acute leukemia

Abstract

The risk of both thromboembolic and bleeding complications is high in acute leukemia. This double hazard has a significant negative impact on the morbidity and mortality of patients with this disease. The clinical manifestations of both complications show special features specific to the form of acute leukemia. Recognition of these characteristics is important in the diagnosis and management of acute leukemia. In this article, several additional issues are addressed, including the features of bleeding and thrombosis in acute promyelocytic leukemia, the current understanding of the leukostasis syndrome and the iatrogenic complications including catheter-associated thrombosis, and the adverse effects of therapeutic agents used in acute leukemia. As regards the bleeding complications, thrombocytopenia is a major cause. Corrective measures, including recent guidelines on platelet transfusions, are provided.

Synergy against PML-RARa: targeting transcription, proteolysis, differentiation, and self-renewal in acute promyelocytic leukemia

“…It is an aggressive disease associated with a high frequency of bleeding and thrombosis, and is rapidly fatal if not properly treated and managed. (Choudhry and DeLoughery, 2012;Kwaan and Huyck, 2010). The vast majority of APL cases are characterized by the fusion of the Nterminus of the promyelocytic leukemia protein (PML) to the C terminus of the retinoic acid receptora (RARa) transcription factor (Borrow et al, 1990;Chomienne et al, 1990;de Thé et al, 1990de Thé et al, , 1991Longo et al, 1990;Alcalay et al, 1991;Kakizuka et al, 1991;Pandolfi et al, 1991) as a result of a balanced chromosomal translocation, t(15;17)(q22;q12; Rowley et al, 1977).…”

2-Arachidonoylglycerol enhances platelet formation from human megakaryoblasts

“…Loss of platelets, due either to decreased survival in the periphery or to reduced production, can occur in several diseases, including thrombocytopenic purpura, acute leukemia, aplastic anaemia, multiple myeloma, HELLP (hemolysis, elevated liver enzymes, low platelets) and Scott (a rare bleeding disorder) syndromes. [5][6][7][8][9][10][11][12] Thrombocytopenia is also a detrimental side effect of chemo-and radio-therapies, often resulting in bleeding episodes, chemotherapy dose reductions or re-scheduling. [13][14][15] Up to date, the most effective approaches for treating the life-threatening complications of thrombocytopenia are platelet transfusion and supplementation with cytokines or thrombopoietic agents.…”

Thrombosis and acute leukemia

“…42 There is a case report of a patient with APL who developed splenic, renal, and intestinal infarction due to severe acquired protein C deficiency; no evidence of disseminated intravascular coagulation was documented. 43 In an Italian study, 44 patients with thrombosis had a higher white blood cell count and an increased prevalence of the short PML/RARA isoform (bcr3), FLT3/ITD, CD2, and CD5 expression. The PETHEMA study 45 did not confirm these thrombosis risk factors.…”