Initial Presentation Of Acute Leukemia Research Articles

Hematoma or Bleeding As Initial Presentation of Chronic Myeloid Leukemia (CML): Review

Background: Chronic myeloid leukemia (CML) is defined per the WHO 2016 classification as a myeloproliferative neoplasm characterized by the chromosomal translocation t (9; 22) (q34.1; q11.2). Patients with CML can have a very wide range of symptoms at presentation. Most patients presents as an incidental finding on a routine complete blood count (CBC). Symptoms might include B symptoms like fever, loss of weight, and night sweats. While splenomegaly is the most common initial presentation in the chronic phase, in accelerated or blast phase of CML, the presentations might resemble acute leukemia with signs and symptoms of anemia, bleeding, petechiae, and ecchymosis. Bleeding might be the initial presentation of acute leukemia; however, it is scarce for CML, especially the chronic phase, to present initially with spontaneous bleeding without coagulopathy and thrombocytopenia. The mechanism behind this rare perennation is not known up to the moment. Methods: A literature search was performed for English language articles using Medline data through PubMed, Scopus, and Google Scholar, for any date up to June 2022. The following keywords were used "CML," "spontaneous bleeding," "bleeding," and "hematoma.". We did not find any retrospective, prospective or clinical trials or reviews on this rare topic. We decided to review all the case reports and case series published in the literature and collect all the general characteristics, common findings, treatment, and outcomes Results: Thirty articles with 30 patients were included. Most of them were males, 23 (76.7%) with a median age was 40 years, and the majority were of Asian origin 13 out of 17 (76.4%). Hematoma sites were different; intracranial was most affected in 11 (36.6%) patients, followed by intraabdominal and musculoskeletal (MSK) bleeding in 9 (30%) patients each. One case was reported as an intrathoracic bleed. All the patients diagnosed with CML chronic phase except one patient in accelerated phase without thrombocytopenia and one presented with blast crisis. Coagulopathy was reported in 2 patients only. The average duration of symptoms was around 6 days, and the median white blood cell count on presentation was 232,000, while 192,000 for platelets and 8.5 gm/dL for hemoglobin. The sequel reported were bilateral deafness in 1 patient, unilateral blindness in 1 patient, and one admission to the intensive care unit. Sixteen (53%) patients received imatinib 400 mg daily. Surgery was done in 12 (40%) patients, and a similar number were treated conservatively. Documented recovery was reported in 10 (33%) patients. Overall survival was reported in 26 patients. 20 (66.6%) were alive, while 6 (33.3%) were dead. The cause of death was reported to be intracranial hemorrhage in 2 cases, sepsis in one case, and splenic rupture in one case. Conclusion: Spontaneous bleeding or hematoma as an initial presentation of CML is rare. Thrombocytopenia and coagulopathy do not explain most of the cases. We hypothesize that male sex, Asian ethnicity, and hyperleukocytosis could be a risk factors. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Multiple intracerebral hemorrhage as initial presentation of acute leukemia: A case report

Intracerebral Hemorrhage had been a harbinger of morbidity and mortality in patients diagnosed with hematologic malignancy. Spontaneous Intracerebral hemorrhage prior to diagnosis is Leukemia however, is very rare and to our knowledge, only 6 have been reported. This is a case of a 21-year-old female, who was rushed to the emergency department due to decrease in sensorium. Patient had no significant headaches, no signs of increased intracranial pressure, and no signs of bruising or bleeding prior. Plain cranial CT scan revealed multiple intracerebral Hemorrhages of at least 18 in number. The Results of cytology revealed Acute Myeloid Leukemia. Several factors from previous comprehensive studies have been highlighted to increase the risk of Intracerebral Hemorrhage amongst these populations. Approximately 5% of patients with Acute leukemia will develop intracerebral hemorrhage and predictors for mortality have different in reported studies. Hyperleukocytosis is a strong consideration for increased mortality, the level of which still undetermined due to lack of literature. Although a probable association between Hyperleukocytosis and survival has been theorized, there is still insufficient data to conclude with certainty. More case reports or retrospective studies are needed so that an association may be established that can help in acute management of these patients.

Leukocytosis: a risk factor for myocardial infarction

Leukocytosis: a risk factor for myocardial infarction Suman K KotlaDepartment of Internal Medicine, Memorial Medical Center, Johnstown, PA, USAAbstract: Myocardial infarction commonly results from atherosclerotic lesions in the coronary arteries. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic disease. In this case report, we present an unusual leukostatic complication in a patient with acute myeloblastic leukemia and extreme hyperleukocytosis who presented with an acute myocardial infarction that resolved after leukopheresis. Myocardial infarction as the initial presentation of acute leukemia has been reported only rarely.Keywords: leukocytosis, myocardial infarction, leukostasis

Two cases of H1N1 influenza infection as the initial presentation of acute leukemia

Pandemic 2009 influenza A virus (H1N1) is a new influenza virus causing illness in human populations. Immunocompromised patients are at high risk for the acquisition of influenza and serious influenza-associated complications. However, there are no reports about patients with both newly diagnosed acute leukemia and H1N1 influenza infection. We reported 2 cases of previously healthy patients with H1N1 influenza infection as the initial presentation of acute leukemia.

INVASIVE ASPERGILLOSIS OF THE SMALL BOWEL IN AN INFANT WITH ACUTE MYELOID LEUKEMIA AND INTESTINAL OBSTRUCTION

Acute myeloid leukemia was diagnosed in an infant with fever and pancytopenia. Intestinal obstruction was present at diagnosis and laparotomy performed after failure of conservative management demonstrated leukemic infiltration of the resected terminal ileum. Fever and intestinal obstruction persisted, necessitating a second ileal resection, which revealed invasive aspergillosis. Subsequent retrospective analysis identified occasional fungal hyphae in the initial resection specimen. With the combination of intensive chemotherapy and aggressive prolonged antifungal therapy the child survived. Invasive aspergillosis may unusually present at nonpulmonary sites at initial presentation of acute leukemia. Microbiological or histological diagnosis is needed to guide aggressive appropriate management.

Cytomegalovirus-related neutropenic enterocolitis with negative CMV antigenemia as the initial presentation in an acute myeloid leukemia patient

Dear Editor, A 35-year-old gentleman, with the past history of diabetes mellitus for 2 years, was transferred to our hospital in 2007 because of cecal enterocolitis with septic shock and pancytopenia. Fever and right lower quadrant (RLQ) abdominal pain without nausea, vomiting, or diarrhea developed 8 days before admission, and he visited another hospital 3 days after onset of symptoms. Pancytopenia with absolute neutrophil count of 250/mL was detected at that time, and abdominal computed tomography (CT) scan revealed prominent wall thickening with submucosal edematous change in cecum and ascending colon. Although broad-spectrum antibiotics were used for several days, abdominal pain and pancytopenia persisted. So, he was transferred to our hospital. On admission, the patient was mildly febrile (37.8°C); physical examination showed distended abdomen with a tenderness over RLQ. Laboratory findings disclosed: white blood cell count, 5.0×10/l (absolute neutrophil count 300/mL, segment 3%, band 3%, blast 15%, atypical lymphocyte 74%), hemoglobin, 11.5 g/dl; platelet, 44× 10/l; C-reactive protein, 156.7 mg/l. After bone marrow exam, acute monocytic leukemia (M5b) was diagnosed. Cefepime, metronidazole, and IV fluid support for bowel rest were given for his neutropenic enterocolitis. He received induction chemotherapy with the regimen, idarubicin 12 mg/m/day for 3 days, and cytarabine 100 mg m day for 7 days. However, fever, abdominal pain, and RLQ tenderness with abdominal fullness persisted even after white blood cell count recovered from nadir. There was no diarrhea or bloody stool during the course. Blood cultures, urinalysis, and stool cultures all yielded negative results. Serology test was negative for anti-HIV. Abdominal CT scan was repeated and revealed thickening of cecal wall with peri-colic inflammation. Because typhlitis with ileus persisted under conservative treatment, he underwent right hemicolectomy. Histological examination of the cecum showed: (1) ulceration and necrotic debris over the mucosal wall of cecum; (2) some enlarged cells with eosinophilic nuclear inclusions (Fig 1.) which were positive for cytomegalovirus (CMV) stain by CMV monoclonal antibody (clone CMV 01, Neomarkers; Fig. 2). The diagnosis of typhlitis with CMV infection was made. CMV-pp65 antigenemia assay, as determined by immunofluorescence, was negative. Three weeks of Ganciclovir was added. No more fever or abdominal pain was noted after operation, and the patient recovered gradually with normal oral intake. Neutropenic enterocolitis or typhlitis is a clinical syndrome in neutropenic patients characterized by fever and abdominal pain. It was originally described in children following induction chemotherapy for acute leukemia [1] and subsequently reported in both adults and children with a variety of hematologic and solid malignancy, in patients with acquired immunodeficiency syndrome, and as a complication of bone marrow transplantation [2]. The development of typhlitis has historically been attributed to a variety of chemotherapeutic regimens. Mucosal injury caused by cytotoxic drugs combined with neutropenia and impaired host defense to intestinal organism leads to the occurrence of typhlitis [3]. However, in this patient, neutropenic enterocolitis is the initial presentation of acute leukemia before treatment of any chemotherapeutic agents Ann Hematol (2009) 88:279–280 DOI 10.1007/s00277-008-0596-3