Severe uterine hemorrhage as first manifestation of acute leukemia

Abstract

Abstract. Abnormal uterine bleeding is one of the most common presentations in gynecology practice with too many causes. Acute promyelocytic leukemia is one of the serious causes of uterine hemorrhage. Frequency and severity of hemorrage seen in acute promyelocytic leukemia is often associated with disseminated intravascular coagulation which can be life-threatening. A 37-year-old women was admitted to the emergency room with acute severe uterine bleeding, increasing weakness and weight loss. There was no gynecologic pathology that could clarify the situation. High suspicion of acute promyelocytic leukemia was noticed during evaluation. All-trans retinoic acid treatment with aggressive blood product support was started immediately. Pathological examination of sternal bone marrow confirmed the suspicions. Our aim is to report a case of massive uterine hemorrhage leading to diagnosis of acute promyelocytic leukemia for the first time and to take attention on acute promyelocytic leukemia as a very rare cause of uterine hemorrhage.

 

Key words: Uterine hemorrhage, thrombocytopenia, acute promyelocytic leukemia, anemia

Keywords

• Uterine hemorrhage, thrombocytopenia, acute promyelocytic leukemia, anemia

Kaynakça

1. De la Serna J, Montesinos P, Vellenga E. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin. Blood 2008; 111: 3395-3402.
2. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol 2003; 122: 10-23.
3. Falanga A, Rickles FR. Pathogenesis and management of the bleeding diathesis in acute promyelocytic leukaemia. Best Practice & Research Clin Haematol 2003; 16: 463-482.
4. Kawai Y, Watanabe K, Kizaki M, et al. Rapid improvement of coagulopathy by all-trans retinoic acid in acute promyelocytic leukemia. Am J Hematol 1994; 46: 184-188.
5. Tallman MS, Andersen JW, Schiffer CA, et al. All- trans retinoic acid in acute promyelocytic leukemia: longterm outcome and prognostic factor analysis from theNorth American Intergroup protocol. Blood 2002; 100: 4298-4302.