Which clinical history findings are characteristic of acute promyelocytic leukemia (APL)?

Updated: May 03, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

APL differs from AML in that most patients present with coagulopathy. The coagulopathy has been described as disseminated intravascular coagulation (DIC) with associated hyperfibrinolysis. APL has been associated with low levels of plasminogen, alpha2-plasmin inhibitor, and plasminogen activator inhibitor 1 found in fibrinolytic states. There is increased expression of annexin II, a receptor for plasminogen and plasminogen-activating factor, on the surface of leukemic promyelocytes. [19] This leads to overproduction of plasmin and fibrinolysis.

It is important to treat the coagulopathy as a medical emergency. In 40% of untreated patients, pulmonary and cerebral hemorrhages can occur. It takes 5-8 days for coagulopathy to improve with treatment.


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