title: A Case of Minimally Differentiated Acute Leukemia (AML-M0) Complicated by Ventricle Thrombosis During Remission-induction.
abstract: Sudden chest pain, dyspnea, and tachypnea occurred in a 21-year-old female who was undergoing induction chemotherapy under a diagnosis of minimally differentiated acute leukemia (M0). The arterial blood gas (ABG) tensions were decreased (PO2 71.6 mm Hg, PCO2 23.7 mm Hg), and an electrocardiogram showed a right-bundle branch block. Coagulation abnormalities (PT 73.1%, APTT 39.4 s, FDP 235mg/dl) were observed 72 h before onset. Echocardiography revealed a large thrombus in a right ventricle. A diagnosis of pulmonary thromboembolism (PTE) was made, and a tissue-type plasminogen activator (monteplase) was administered under percutaneous cardiopulmonary support (PCPS). The complete lysis of thrombus was confirmed by an echocardiogram 8 h later. Symptoms and ABG data were also improved. PTE in adult AML cases is rare, but should be considered as one of the life-threatening complications in AML patients under chemotherapy who develop respiratory difficulties. We suggest a careful monitoring of coagulation abnormalities for the prediction of PTE during chemotherapy for AML, and the use of tissue-type plasminogen activator (t-PA), monteplase, for the treatment of PTE in these cases.
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nozaki
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sono
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: M
authors.initials: M
authors.lastname: Matsuda
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: a Third Department of Internal Medicine , Kinki University, School of Medicine , 377-2, Ohno-Higashi, Osaka - Sayama , 589-8511 , Osaka , Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kanamaru
mesh_terms: D000328:Adult; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced / Q000188:drug therapy*; D006352:Heart Ventricles; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: C468277:monteplase; D010960:Plasminogen Activators
keywords: AML (M0); Percutaneous cardiopulmonary support; Pulmonary thromboembolism; Tissue-type plasminogen activator