Acute promyelocytic leukemia is characterized by the association with a severe coagulopathy
resulting in hemorrhagic manifestations. The pathogenesis underlying the hemorrhagic
syndrome is complex and involves the activation of the coagulation cascade and the
fibrinolytic system. All-trans-retinoic acid (ATRA) appears to correct both procoagulant and fibrinolytic activities
in vitro and in vivo. Early results of treatment with arsenic trioxide, which acts
by inducing apoptosis of the leukemic promyelocytes, also show regression in the coagulopathy
with a decrease in fibrin degradation products and D-Dimer. A clear understanding
of the relationship between laboratory changes and the effects of ATRA and arsenic
trioxide requires further studies.
Acute promyelocytic leukemia - all-trans-retinoic acid - hemorrhage - coagulopathy - disseminated intravascular coagulation
(DIC)
