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Case Report: ANXA2 Associated Life-Threatening Coagulopathy With Hyperfibrinolysis in a Patient With Non-APL Acute Myeloid Leukemia.
- Source :
-
Frontiers in oncology [Front Oncol] 2021 Apr 15; Vol. 11, pp. 666014. Date of Electronic Publication: 2021 Apr 15 (Print Publication: 2021). - Publication Year :
- 2021
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Abstract
- Patients with acute promyelocytic leukemia (APL) often present with potentially life-threatening hemorrhagic diathesis. The underlying pathomechanisms of APL-associated coagulopathy are complex. However, two pathways considered to be APL-specific had been identified: 1) annexin A2 (ANXA2)-associated hyperfibrinolysis and 2) podoplanin (PDPN)-mediated platelet activation and aggregation. In contrast, since disseminated intravascular coagulation (DIC) is far less frequent in patients with non-APL acute myeloid leukemia (AML), the pathophysiology of AML-associated hemorrhagic disorders is not well understood. Furthermore, the potential threat of coagulopathy in non-APL AML patients may be underestimated. Herein, we report a patient with non-APL AML presenting with severe coagulopathy with hyperfibrinolysis. Since his clinical course resembled a prototypical APL-associated hemorrhagic disorder, we hypothesized pathophysiological similarities. Performing multiparametric flow cytometry (MFC) and immunofluorescence imaging (IF) studies, we found the patient's bone-marrow mononuclear cells (BM-MNC) to express ANXA2 - a biomarker previously thought to be APL-specific. In addition, whole-exome sequencing (WES) on sorted BM-MNC (leukemia-associated immunophenotype (LAIP)1: ANXA <superscript>lo</superscript> , LAIP2: ANXA <superscript>hi</superscript> ) demonstrated high intra-tumor heterogeneity. Since ANXA2 regulation is not well understood, further research to determine the coagulopathy-initiating events in AML and APL is indicated. Moreover, ANXA2 and PDPN MFC assessment as a tool to determine the risk of life-threatening DIC in AML and APL patients should be evaluated.<br />Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.<br /> (Copyright © 2021 Ruhnke, Stölzel, Wagenführ, Altmann, Platzbecker, Herold, Rump, Schröck, Bornhäuser, Schetelig and von Bonin.)
Details
- Language :
- English
- ISSN :
- 2234-943X
- Volume :
- 11
- Database :
- MEDLINE
- Journal :
- Frontiers in oncology
- Publication Type :
- Report
- Accession number :
- 33937079
- Full Text :
- https://doi.org/10.3389/fonc.2021.666014