RESUMO
BACKGROUND: Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia. In recent years, with platelet transfusion increasing, ineffective platelet transfusion has become increasingly prominent. Generally speaking, platelet antibodies can be produced after repeated transfusion, thus rendering subsequent platelet transfusion ineffective. We report a case of first platelet transfusion refractoriness (PTR) in a patient with acute myelocytic leukemia (AML). Due to the rarity of such cases in clinical practice, there have been no relevant case reports so far. CASE SUMMARY: A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d. Her diagnosis was acute myelocytic leukemia [M2 type Fms related receptor tyrosine kinase 3, Isocitrate Dehydrogenase 1, Nucleophosmin 1, Neuroblastoma RAS viral oncogene homolog (+) high-risk group]. She was treated with "IA" (IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5) chemotherapy. When her condition improved, the patient was discharged from the hospital, instructed to take medicine as prescribed by the doctor after discharge, and returned to the hospital for further chemotherapy on time. CONCLUSION: We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy, which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load. This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML. When platelet antibodies are produced, immunoglobulins can be used to block antibodies, thereby reducing platelet destruction. For patients with PTR, both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.
RESUMO
To investigate the clinical characteristics of acute myeloid leukemia (AML) with biliary obstruction as the first manifestation and explore the treatment options. A retrospective analysis was performed on a case of AML with biliary obstruction as the first manifestation admitted to the First Affiliated Hospital of Jishou University (Jishou, China). The relevant laboratory examination, imaging, pathological results and treatment strategies were analyzed. The patient was a 44-year-old male with an initial manifestation of biliary obstruction. Combined with the results of laboratory tests and bone marrow aspiration, the patient was diagnosed with AML and was treated with an IA regimen (idarubicin 8 mg d1-3, cytarabine 0.2 d1-5). After 2 courses of treatment, complete response was achieved, the liver function returned to normal and the biliary obstruction disappeared. The initial symptoms of AML are varied, and always combine with multi-system organ damage. Early diagnosis and active treatment of primary diseases are the keys to improving the prognosis of these patients.
