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AML-M5 and DIC Morning Report

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Title: AML-M5 and DIC Morning Report


1
AML-M5 and DICMorning Report
  • Tuesday, July 24, 2007
  • Dave Rometo

2
Acute Myelogenous Leukemia
  • M1 myeloblastic
  • M2 myeloblastic with maturation
  • M3 promyelocytic
  • M4 myelomonocytic
  • M5 monocytic
  • M6 erythroleukemia
  • M7 megakaryoblastic

3
AML-M5 Acute Monocytic Leukemia
  • 7-15 of adult ANLL
  • gt20 blasts in marrow
  • gt80 of blasts of monocytic lineage
  • M5a monocytic cells gt80 monoblasts
  • M5b lt80 (mixture with promonocytes)
  • Monocytic markers CD11b, CD11c

4
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6
DIC
  • Disseminated intravascular coagulation
  • i.e. Consumption coagulopathy, Defibrination
    syndrome
  • Systemic, /- thrombosis, /- hemorrhage

7
Components
  • Exposure of blood to procoagulants
  • Formation of fibrin in the circulation
  • Fibrinolysis
  • Depletion of clotting factors
  • End-organ damage

8
Pathogenesis
  • Generation of thrombin overwhelms the
    antithrombotic pathways
  • Thrombin circulates-gt widespread deposition of
    fibrin
  • Tissue ischemia
  • Consumption of platelets, fibrinogen,
    prothrombin, factor V and VIII

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11
Acute (decompensated)
  • Bleeding diathesis predominates
  • Liver and bone marrow cannot compensate for
    consumption
  • Unlike chronic, where thrombosis predominates

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13
Etiology
  • Sepsis
  • Trauma
  • Malignancy
  • Obstetrical complications (i.e. amniotic fluid
    embolism and abruptio placenctae)

14
DIC in Malignancy
  • 7 of clin. sig. DIC
  • Usually chronic, thrombotic (Trousseaus)
  • Acute in AML-M3, promyelocytic
  • Pulmonary or cerebrovascular hemorrhage
  • In M3, tx w/ all-trans-retinoic acid induces cell
    differentiation

15
Diagnosis labs
  • Platelets lt 100K
  • High FDP, D-dimer (accelerated fibrinolysis)
  • High PT (factors II, V, VII, X)
  • High aPTT (8,9,11,12)
  • Low fibrinogen, but may be elevated as acute
    phase reactant
  • Low AT (sensitive for poor prognosis)

16
Factor replacement
  • FFP, thawed plasma, and 24 hour frozen plasma
    (one unit) All soluble plasma proteins from one
    unit of whole blood. Correction of bleeding due
    to excess warfarin, vitamin K deficiency, or
    deficiency of multiple coagulation factors (eg,
    DIC, liver disease, dilutional coagulopathy).
    Initial dose 15 mL/kg. Treatment of TTP-HUS
  • Cryo-precipitate (one bag) 10-15 mL of cold
    insoluble protein from one unit of FFP
    Pasteurized contains vWF, factors VIII, XIII,
    fibrinogen, fibrinonectin. Source of fibrinogen
    (200 mg/bag). For bleeding in vWD 1 bag/10 kg q
    6-12 hrFactor XIII deficiency 1 bag/10 kg
    usually onceFactor VIII deficiency 100
    units/bag. This use is outmoded recombinant
    factor VIII should be used

17
Acknowledgements
  • UpToDate.com (e-mail yourself an article from
    work to get a 1 month free access from
    home/anywhere)
  • Dr. Thomas Stinchcombe
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