Acute myelogenous leukemia: implications of acute blast crisis and cardiopulmonary bypass

Abstract

CUTE MYELOCYTIC leukemia (AML) is a disorder characterized by the expansion of an abnormal white blood cell line. This clonal expansion of cells may infiltrate the bone marrow and other organs, suppressing normal hematopoiesis and inducing dysfunction of the invaded organs. Clinical manifestations of this disease, therefore, result from lack of normal blood cells (primarily due to decreased production) and induced organ dysfunction (secondary to cellular infiltration and/or local hemorrhage). Although the exact incidence of coagulation abnormalities is not known, thrombohemorrhagic complications are certainly common in patients with AML (20% incidence of fatal hemorrhage), especially compared to chronic leukemias; blast crisis accentuates this potential. Although isolated case reports of thrombosis of venous and mammary artery grafts have been reported in patients requiring coronary artery bypass grafting (CABG) with concurrent stable chronic leukemia, nothing has been reported regarding potential thrombohemorrhagic events during acute blast crisis. Hence, a case is presented in which urgent CABG was performed in a patient with AML complicated by a recently diagnosed blast crisis.