Emergency Cesarean Section with Acute Promyelocytic Leukemia and Disseminated Intravascular Coagulation - A Case Report-Emergency Cesarean Section with Acute Promyelocytic Leukemia and Disseminated Intravascular Coagulation

Emergency Cesarean Section with Acute Promyelocytic Leukemia and Disseminated Intravascular Coagulation - A Case Report

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This case report in the AANA Journal discusses the complexities of managing acute promyelocytic leukemia (APML) during pregnancy, particularly when complicated by disseminated intravascular coagulation (DIC). APML is a rare and aggressive leukemia caused by a genetic translocation between chromosomes 15 and 17, leading to the accumulation of immature promyelocytes. This disorder often results in consumptive coagulopathy and severe hemorrhage, potentially endangering both maternal and fetal lives if not promptly diagnosed and treated.<br /><br />The case highlights a 19-year-old pregnant woman at 31 weeks gestation who presented with fatigue and excessive vaginal bleeding, suspected to have placental abruption. Diagnosed with APML and DIC, she required an emergency cesarean section due to respiratory distress and potential threats to her and her baby's health. Treatment usually involves a rapid initiation of therapies, including all-trans retinoic acid (ATRA) for APML.<br /><br />An interdisciplinary medical team plays a crucial role in strategizing the treatment plan, adjusting chemotherapy timing, and ensuring the safety of both mother and child. The multidisciplinary approach enabled a favorable outcome with the mother being treated with ATRA, hydroxyurea, and subsequently, idarubicin post-surgery. Despite the high-risk factors associated with severe hemorrhage and complications, the successful management of this case underscores the importance of teamwork and cohesive planning in acute settings. <br /><br />This report stresses the ethical challenges and treatment nuances in handling APML in pregnancy, emphasizing timely diagnosis and interdisciplinary coordination to enhance survival chances for mother and child, despite the high risks and potential for adverse outcomes.

Keywords

acute promyelocytic leukemia

pregnancy

disseminated intravascular coagulation

consumptive coagulopathy

cesarean section

all-trans retinoic acid

interdisciplinary team

chemotherapy

ethical challenges

multidisciplinary approach