SHM Converge Scientific Abstract ePoster Gallery-Management of Submassive Pulmonary Embolism in Thrombocytopenic Acute Myeloid Leukemia

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An 84-year-old woman with asthma and hypertension presented after more than a week of generalized weakness, poor oral intake, and somnolence, with a 3-month history of 30-pound weight loss, intermittent fevers, and chronic productive cough. On arrival she was critically ill with fever to 105.5°F, hypotension, hypoxia, right leg edema, acute kidney injury, and marked leukocytosis (WBC 79 K/uL with 78% blasts), anemia, thrombocytopenia, and laboratory evidence of overt disseminated intravascular coagulation. Cardiac markers were elevated, and CT angiography showed bilateral pulmonary emboli with ground-glass opacities; echocardiography demonstrated right ventricular enlargement, consistent with submassive PE. Lower-extremity imaging also confirmed DVT.<br /><br />Bone marrow aspirate revealed acute myeloid leukemia with mutated NPM1 and associated FLT3, NPM1, and WT1 molecular alterations. The patient was initially treated with tretinoin, hydroxyurea, rasburicase, allopurinol, empiric antibiotics, and heparin using a platelet-guided anticoagulation strategy. Blood cultures grew Bacillus cereus and methicillin-resistant Staphylococcus epidermidis, requiring meropenem and vancomycin. Her course was complicated by worsening tumor lysis syndrome, limited ability to give aggressive fluids because of right ventricular strain, and renal failure requiring ICU transfer for leukapheresis and continuous renal replacement therapy. Midostaurin was later held due to hypercapnic respiratory failure and intubation, though she was successfully extubated after five days.<br /><br />Subsequently, she received decitabine, venetoclax, and midostaurin with good hematologic response. Once platelets stabilized, anticoagulation was transitioned from heparin to enoxaparin, and she was discharged on enoxaparin with outpatient follow-up.<br /><br />The case highlights the need for early escalation of care in AML complicated by thrombosis, sepsis, and tumor lysis syndrome, and supports individualized, platelet-guided anticoagulation to balance bleeding and clotting risk.

Asset Subtitle

Jervon Wright

Meta Tag

Author List Benjamin Palter, Hatice D. Gur, Jervon Wright, Michael Vaysblat, Spencer F. Weintraub

Category Clinical Vignettes

Concept Acute Myeloid Leukemia

Concept Hypercoagulable State

Concept Bleeding Risk

Concept Thrombocytopenia

Concept Pulmonary Embolism

Distinguished Non-Finalist

Presenter Organization Donald & Barbara Zucker School of Medicine at Hofstra/Northwell

Presenting Author Jervon Wright

Track Adult

Keywords

acute myeloid leukemia

NPM1 mutation

FLT3 alteration

disseminated intravascular coagulation

pulmonary embolism

deep vein thrombosis

tumor lysis syndrome

platelet-guided anticoagulation

sepsis

venetoclax decitabine therapy

Acute Myeloid Leukemia

Hypercoagulable State

Bleeding Risk

Thrombocytopenia

Pulmonary Embolism