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Published on: March 26, 2018
Syncope as Initial Presentation in an Undifferentiated Type Acute Myeloid Leukemia Patient with Acute Intracranial
Meng-Yu Wu1,2, Ching-Hsiang Lin1,2, Yueh-Tseng Hou1,2
1Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
Abstract:
Intracranial hemorrhage (ICH) is a catastrophic complication in patients with acute myeloid leukemia (AML). AML cells, especially in the acute promyelocytic leukemia subtype, may release microparticles (MPs), tissue factor (TF), and cancer procoagulant (CP) to promote coagulopathy. Hyperfibrinolysis is also triggered via release of annexin II, t-PA, u-PA, and u-PAR. Various inflammatory cytokines from cancer cells, such as IL-1β and TNF-α, activate endothelial cells and promote leukostasis. This condition may increase the ICH risk and lead to poor clinical outcomes. Here, we present a case under a unique situation with acute ICH detected prior to the diagnosis of AML. The patient initially presented with two episodes of syncope. Rapidly progressive ICH was noted in follow-up computed tomography (CT) scans. Therefore, we highlight that AML should be among the differential diagnoses of the etiologies of ICH. Early diagnosis and timely intervention are very important for AML patients.
Insights
Acute myeloid leukemia (AML) can cause intracranial hemorrhage (ICH) through coagulopathy and hyperfibrinolysis. This case highlights ICH as a potential early sign of AML, emphasizing prompt diagnosis.
Area of Science:
- Hematology
- Neurology
- Oncology
Background:
- Intracranial hemorrhage (ICH) is a severe complication in acute myeloid leukemia (AML) patients.
- AML cells can trigger coagulopathy and hyperfibrinolysis, increasing ICH risk.
Observation:
- A unique case presented with acute ICH preceding AML diagnosis.
- Initial symptoms included syncope, with rapid ICH progression noted on CT scans.
Findings:
- AML should be considered in the differential diagnosis of ICH.
- The interplay of microparticles, tissue factor, cancer procoagulant, and fibrinolytic factors contributes to ICH in AML.
Implications:
- Early diagnosis of AML in ICH patients is critical for timely intervention.
- Recognizing ICH as a potential early indicator can improve outcomes for AML patients.
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