DÄ internationalArchive29-30/2015Exemption: Promyelocytic Leukemia
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Wandt et al. have rightly pointed out that in many clinically stable patients with hematologic malignancies, the transfusion trigger can be set at <10 000/μL (1).

However, there is the exemption of promyelocytic leukemia. As the result of hyperfibrinolysis, the degradation of coagulation factors by proteolytic enzymes from the leukemia cells, and of cytokines, patients with this type of leukemia can develop disseminated intravascular coagulation (DIC) and ultimately a rapidly life-threatening coagulopathy (2).

According to German and international guidelines, platelet counts should be maintained at 30 000–50 000/μL in these patients (3, 4). Replacement treatment should be started very early, at times even before the diagnosis has been confirmed by molecular genetic testing (2).

DOI: 10.3238/arztebl.2015.0505b

Prof. Dr. med Jörg Mezger

Medizinischen Klinik 2–Hämatologie,
Onkologie, Immunologie, Palliativmedizin

St. Vincentius-Kliniken Karlsruhe

joerg.mezger@vincentius-ka.de

1.
Wandt H, Schäfer-Eckart K, Greinacher A: Platelet transfusion in hematology, oncology and surgery. Dtsch Arztebl Int 2014; 111: 809–15 VOLLTEXT
2.
Choudhry H, DeLoughery PG: Bleeding and thrombosis in acute proymyelocytic leukemia. Am J Hematol 2012; 87: 596–603 CrossRef MEDLINE
3.
Lengfelder E, Lambert J-F, Nachbaur D, et al.: Akute Promyelozytäre Leukämie (APL) Leitlinie. Empfehlungen der Fachgesellschaft zur Diagnostik und Therapie hämatologischer und onkologischer Erkrankungen. www.dgho-onkopedia.de/de/onkopedia/leitlinien/akute-promyelozytaere-leukaemie (last accessed on 16 March 2015).
4.
Döhner H, Estey EH, Amadori S, et al.: Recommendations from an international expert panel on behalf of the European LeukemiaNet. Blood 2009; 113: 1875–91 CrossRef MEDLINE
1.Wandt H, Schäfer-Eckart K, Greinacher A: Platelet transfusion in hematology, oncology and surgery. Dtsch Arztebl Int 2014; 111: 809–15 VOLLTEXT
2.Choudhry H, DeLoughery PG: Bleeding and thrombosis in acute proymyelocytic leukemia. Am J Hematol 2012; 87: 596–603 CrossRef MEDLINE
3.Lengfelder E, Lambert J-F, Nachbaur D, et al.: Akute Promyelozytäre Leukämie (APL) Leitlinie. Empfehlungen der Fachgesellschaft zur Diagnostik und Therapie hämatologischer und onkologischer Erkrankungen. www.dgho-onkopedia.de/de/onkopedia/leitlinien/akute-promyelozytaere-leukaemie (last accessed on 16 March 2015).
4. Döhner H, Estey EH, Amadori S, et al.: Recommendations from an international expert panel on behalf of the European LeukemiaNet. Blood 2009; 113: 1875–91 CrossRef MEDLINE

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