PDF(Pubmed)
Abstract：
Acute myeloid leukemia (AML), the most common form of acute leukemia, is an aggressive lethal hematological malignancy that mainly occurs in older adults with a slightly higher predominance in males. It is prompted by the clonal expansion of immature myeloid blasts in the bone marrow, peripheral blood, and/or extramedullary tissues. Leukostasis in AML is a critical medical condition mainly affecting the lungs and brain and arises when tissue perfusion is compromised due to the clustering of white blood cells (WBCs) within the microvasculature. Cardiac involvement in this condition is exceptionally uncommon. Here, we present a case of a 56-year-old man, recently diagnosed with acute myelogenous leukemia M4 and leukostasis, who developed acute anterior ST-elevation myocardial infarction six days after presentation and in whom emergent coronary angiography showed proximal left anterior descending (LAD) artery lesion with a large clot obstructing the flow and thrombolysis in myocardial infarction (TIMI) I flow, and urgent percutaneous coronary intervention (PCI) was done; thromboaspiration and drug-coated balloon angioplasty were performed with good angiographic results. Antiplatelet (aspirin and clopidogrel) and anticoagulation (enoxaparin) were started immediately before PCI. Emergent leukapheresis was initiated in addition to hydroxyurea with complete resolution of chest pain. Four days post PCI, the patient developed right-sided hemiparesis with an evident infarct on a CT scan of the brain, and he also developed acute limb ischemia involving the distal right foot. Five days post PCI, the patient had a sudden sustained ventricular tachycardia followed immediately by asystole, and cardio-pulmonary resuscitation was done for 25 minutes but with no response.
摘要：
急性髓系白血病(AML),最常见的急性白血病，是一种侵袭性致死性血液恶性肿瘤，主要发生在老年人中，男性占主导地位。它是由骨髓中未成熟的骨髓母细胞的克隆扩增引起的，外周血,和/或髓外组织。AML中的白细胞停滞是主要影响肺和脑的关键医学病症,并且当组织灌注由于微脉管系统内的白细胞(WBC)聚集而受损时出现。这种情况下的心脏受累异常罕见。这里,我们提出一个56岁男子的案例,最近被诊断患有急性骨髓性白血病M4和白细胞淤滞，出现后六天出现急性ST段抬高型心肌梗死，急诊冠状动脉造影显示左前降支（LAD）近端动脉病变，大血块阻碍了心肌梗死（TIMI）I流的血流和溶栓，并进行了紧急经皮冠状动脉介入治疗(PCI);进行了血栓抽吸术和药物涂层球囊血管成形术,血管造影结果良好.在PCI前立即开始抗血小板（阿司匹林和氯吡格雷）和抗凝（依诺肝素）。除羟基脲外，还开始了紧急白细胞去除术，可完全缓解胸痛。PCI术后四天，患者在脑部CT扫描中出现右侧偏瘫，并伴有明显的梗塞，他还出现了累及右足远端的急性肢体缺血。PCI术后五天，患者突然出现持续性室性心动过速，随后立即出现心搏停止，心肺复苏25分钟，但无反应。
