Thrombosis during all-trans-retinoic acid therapy in a child with acute promyelocytic leukemia and factor VQ 506 mutation

Acute promyelocytic leukemia (APL) is often associated with a severe hemost atic disorder, caused bg the release of procoagulant and fibrinolytic subst ances from leukemic blasts. The coagulation profile may exhibit disseminate d intravascular coagulation and fibrinolysis or proteolysis. Therefore, hep arin and antifibrinolytic agents alone or in combination have been used to prevent severe bleedings. Remission induction with all-trans-retinoic acid (ATRA) is accompanied with rapid correction of hemostatic abnormalities. Th rombosis is a rare complication of APL and may be due to the alterations in hemostasis caused by the disease itself as well as ATRA and antifibrinolyt ics. Here, the occurrence of thrombosis during induction treatment with ATR A combined with aprotinin and chemotherapy is described in a patient who is homozygous for factor VQ 506 mutation.