Case Report: ANXA2 Associated Life-Threatening Coagulopathy With Hyperfibrinolysis in a Patient With Non-APL Acute Myeloid Leukemia

Research output: Contribution to journalResearch articleContributed

Contributors

  • Leo Ruhnke - , University Hospital Carl Gustav Carus Dresden (Author)
  • Friedrich Stölzel - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Lisa Wagenführ - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Heidi Altmann - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden, National Center for Tumor Diseases (NCT) Dresden, German Cancer Consortium (DKTK) Partner Site Dresden, German Cancer Research Center (DKFZ) (Author)
  • Uwe Platzbecker - , University Hospital Leipzig (Author)
  • Sylvia Herold - , University Hospital Carl Gustav Carus Dresden (Author)
  • Andreas Rump - , Institute of Clinical Genetics, National Center for Tumor Diseases (NCT) Dresden, German Cancer Consortium (DKTK) Partner Site Dresden, German Cancer Research Center (DKFZ) (Author)
  • Evelin Schröck - , Institute of Clinical Genetics, National Center for Tumor Diseases (NCT) Dresden, German Cancer Consortium (DKTK) Partner Site Dresden, German Cancer Research Center (DKFZ) (Author)
  • Martin Bornhäuser - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden, National Center for Tumor Diseases (NCT) Dresden, German Cancer Consortium (DKTK) Partner Site Dresden, German Cancer Research Center (DKFZ) (Author)
  • Johannes Schetelig - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Malte von Bonin - , University Hospital Carl Gustav Carus Dresden (Author)

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: ANXAlo, LAIP2: ANXAhi) 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.

Details

Original languageEnglish
Pages (from-to)666014
JournalFrontiers in oncology
Volume11
Publication statusPublished - 2021
Peer-reviewedNo

External IDs

PubMedCentral PMC8082174
Scopus 85105021235

Keywords