Document Detail

Acute myocardial infarction as the presenting symptom of acute myeloblastic leukemia with extreme hyperleukocytosis.
MedLine Citation:
PMID:  12221675     Owner:  NLM     Status:  MEDLINE    
This case report deals with an unusual leukostatic complication in a 56-year-old woman with acute myeloblastic leukemia (AML) and extreme hyperleukocytosis (316 x 10(9)/L) who presented with acute myocardial infarction (MI). After leukopheresis the patient achieved hemodynamic stabilization and rapid neurologic recovery of encephalopathy that had also developed after the infarction. Considering the central role of WBC in the remodeling of post MI myocardial tissue, it was obvious that administration of chemotherapy with its subsequent inevitable pancytopenia could impose an increased risk for further cardiac complications including myocardial rupture. Nevertheless, cytarabine-based induction chemotherapy was initiated 3 days after admission, and she achieved prolonged complete remission. Coronary angiography disclosed segmental atherosclerosis, but the only significant obstruction was in the right coronary artery. The patient died with relapsed leukemia 7 years later without recurrence of any cardiac symptoms or signs. Autopsy disclosed segmental coronary atherosclerosis involving the LAD (60% obstruction), suggesting that atherosclerosis was a predisposing risk factor. Additional compromise to blood perfusion due to leukostasis had led to this unusual complication of AML involving a major vessel. This is the first documented case of leukostasis causing coronary artery occlusion as well as the first report of successful induction chemotherapy for AML during a myocardial infarction.
Yossi Cohen; Gail Amir; Nael Da'as; Shmuel Gillis; Deborah Rund; Aaron Polliack
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  71     ISSN:  0361-8609     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-10     Completed Date:  2002-10-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  47-9     Citation Subset:  IM    
Copyright Information:
Copyright 2002 Wiley-Liss, Inc.
Department of Hematology, Hadassah University Hospital, Jerusalem, Israel.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Antibodies, Monoclonal / therapeutic use
Antigens, CD / immunology
Antigens, Differentiation, Myelomonocytic / immunology
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Combined Modality Therapy
Confusion / etiology,  therapy
Cytarabine / administration & dosage
Etoposide / administration & dosage
Fatal Outcome
Idarubicin / administration & dosage
Leukemia, Myeloid, Acute / blood,  complications*,  diagnosis,  drug therapy,  therapy
Leukocytosis / etiology*,  therapy
Middle Aged
Mitoxantrone / administration & dosage
Myocardial Infarction / etiology*
Remission Induction
Salvage Therapy
Vidarabine / administration & dosage,  analogs & derivatives
Reg. No./Substance:
0/Aminoglycosides; 0/Anti-Bacterial Agents; 0/Antibodies, Monoclonal; 0/Antigens, CD; 0/Antigens, Differentiation, Myelomonocytic; 0/CD33 antigen; 0/gemtuzumab; 147-94-4/Cytarabine; 21679-14-1/fludarabine; 33419-42-0/Etoposide; 5536-17-4/Vidarabine; 58957-92-9/Idarubicin; 65271-80-9/Mitoxantrone

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