ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT

Objective: Asparaginase has a very important role in ALL treatment among increasing of remission rate and duration. Multiple side effects prevent its regulatory use. Asparaginase reduce antithrombin 3, heparin cofactor II, protein C and plasminogen synthesis. By the way, P-selectin, PAI 1, tissue fa...

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Autores principales:	Beyza OLUK, Özden ÖZLÜK, Murat ÖZBALAK, Simge ERDEM, Sevgi KALAYOĞLU BEŞIŞIK
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/78145493b93d4c6f9cd9f42e79dff82c
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spelling	oai:doaj.org-article:78145493b93d4c6f9cd9f42e79dff82c2021-11-10T04:34:30ZASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT2531-137910.1016/j.htct.2021.10.1011https://doaj.org/article/78145493b93d4c6f9cd9f42e79dff82c2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2531137921011585https://doaj.org/toc/2531-1379Objective: Asparaginase has a very important role in ALL treatment among increasing of remission rate and duration. Multiple side effects prevent its regulatory use. Asparaginase reduce antithrombin 3, heparin cofactor II, protein C and plasminogen synthesis. By the way, P-selectin, PAI 1, tissue factor activity, and vWF antigen levels increase. Hypofibrinogenemia may be a marker of of hemostasis disturbances and decreased protein synthesis. Case report: A 25-year-old male patient with acute T-cell lymphoblastic leukemia diagnosis was initiated on induction chemotherapy according to augmented BFM protocol. After 4 weeks, remission was confirmed. During consolidation with the third dose of standard L-asparaginase of 10000 units, headache, nausea and vomiting started and confusion developed. Biochemical investigations, PT, aPTT were within normal limits. Fibrinogen was 92 mg/dL and D-dimer was high.Contrast-enhanced MRI showed a thrombus occluding. Methodology: the superior sagittal sinus. He was intubated and followed up in the intensive care unit due to a rapid decline in the Glasgow score and epileptic seizures. Correction of fibrinogen with cryoprecipitate anticoagulation treatment contributed to symptoms improvement. unfortunately, asparaginase was removed from the protocol. During maintenance therapy, he has had severe COVID-19 pneumonia and during this time he did not experience any thrombosis related complications. Results: Asparaginase therapy is associated with low antithrombin and fibrinogen levels and 7% of thrombosis rate. Previous studies showed that, in ALL patients, thrombosis occurred far more frequently during cycles that contained asparaginase than those that did not. Conclusion: Therefore, studies have investigated the role of fresh frozen plasma or cryoprecipitate supplementation to reduce the thrombohemorrhagic risk of therapy. Retrospective studies suggest antithrombin concentrates may have a beneficial effect on the outcomes of adults treated with asparaginase for ALL.Beyza OLUKÖzden ÖZLÜKMurat ÖZBALAKSimge ERDEMSevgi KALAYOĞLU BEŞIŞIKElsevierarticleDiseases of the blood and blood-forming organsRC633-647.5ENHematology, Transfusion and Cell Therapy, Vol 43, Iss , Pp S33- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	Diseases of the blood and blood-forming organs RC633-647.5 Beyza OLUK Özden ÖZLÜK Murat ÖZBALAK Simge ERDEM Sevgi KALAYOĞLU BEŞIŞIK ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
description	Objective: Asparaginase has a very important role in ALL treatment among increasing of remission rate and duration. Multiple side effects prevent its regulatory use. Asparaginase reduce antithrombin 3, heparin cofactor II, protein C and plasminogen synthesis. By the way, P-selectin, PAI 1, tissue factor activity, and vWF antigen levels increase. Hypofibrinogenemia may be a marker of of hemostasis disturbances and decreased protein synthesis. Case report: A 25-year-old male patient with acute T-cell lymphoblastic leukemia diagnosis was initiated on induction chemotherapy according to augmented BFM protocol. After 4 weeks, remission was confirmed. During consolidation with the third dose of standard L-asparaginase of 10000 units, headache, nausea and vomiting started and confusion developed. Biochemical investigations, PT, aPTT were within normal limits. Fibrinogen was 92 mg/dL and D-dimer was high.Contrast-enhanced MRI showed a thrombus occluding. Methodology: the superior sagittal sinus. He was intubated and followed up in the intensive care unit due to a rapid decline in the Glasgow score and epileptic seizures. Correction of fibrinogen with cryoprecipitate anticoagulation treatment contributed to symptoms improvement. unfortunately, asparaginase was removed from the protocol. During maintenance therapy, he has had severe COVID-19 pneumonia and during this time he did not experience any thrombosis related complications. Results: Asparaginase therapy is associated with low antithrombin and fibrinogen levels and 7% of thrombosis rate. Previous studies showed that, in ALL patients, thrombosis occurred far more frequently during cycles that contained asparaginase than those that did not. Conclusion: Therefore, studies have investigated the role of fresh frozen plasma or cryoprecipitate supplementation to reduce the thrombohemorrhagic risk of therapy. Retrospective studies suggest antithrombin concentrates may have a beneficial effect on the outcomes of adults treated with asparaginase for ALL.
format	article
author	Beyza OLUK Özden ÖZLÜK Murat ÖZBALAK Simge ERDEM Sevgi KALAYOĞLU BEŞIŞIK
author_facet	Beyza OLUK Özden ÖZLÜK Murat ÖZBALAK Simge ERDEM Sevgi KALAYOĞLU BEŞIŞIK
author_sort	Beyza OLUK
title	ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
title_short	ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
title_full	ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
title_fullStr	ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
title_full_unstemmed	ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT
title_sort	asparaginase induced sinus vein thrombosis in an adult young all patient
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/78145493b93d4c6f9cd9f42e79dff82c
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_version_	1718440569909280768

ASPARAGINASE INDUCED SINUS VEIN THROMBOSIS IN AN ADULT YOUNG ALL PATIENT

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